Acute rheumatic fever: subcutaneous nodules and carditis.

We present images of an 8-year-old child with a fever for the preceding 45 days, migratory polyarthralgia involving large joints, and progressively worsening dyspnea on exertion. Examination revealed subcutaneous nodules over the bony prominences of the spine, scapulae, forehead, extensor surfaces of bilateral elbow joints and knee joints, ankles, and the rib cage (Figure 1). The nodules were 0.5 to 1.5 cm in size, rounded, firm, nontender, and mobile. A …