Rare Symptoms
Erythema marginatum
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Highly specific to ARF
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Cutaneous lesion: reddish pink borderpale centreround or irregular shape
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Often on trunk, abdomen, inner arms or thighs
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Highly suggestive of carditis
Subcutaneous nodules
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Usually 0.5-2cm in diameter: Firm, non-tender, isolated or in clusters
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Most common along on the extensor surfaces of the joint: knees, elbows, wrist
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Also on bony prominences, tendons, dorsi of feet, occiput or cervical spine.
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Last a few days only
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Often associated with carditis
Sydenham’s Chorea
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Extrapyramidal disorder:
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Fast, clonic involuntary movements (especially face and limbs)
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Muscular hypotonus
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Emotional lability
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First sign: difficulty walking, talking, writing
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Usually a late manifestation, can be months after infection
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May be the only manifestation of ARF
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Often associated with carditis
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Usually benign and resolves in 2-3 months
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But can last for more than 2 years
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