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Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
Erythema marginatum [205] is a bright-pink or faint-red, blanching non-pruritic rash that affects the trunk and proximal limbs and spares the face. Erythema marginatum occurs early in the disease and may persist or recur. The rash is usually only seen in patients with concomitant carditis.
Valve disease
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
In the UK, streptococcal sore throats are generally treated with penicillin (primary prevention of rheumatic fever), so acute rheumatic fever is rarely seen in the UK. Rheumatic heart disease complicates 3% of untreated patients, and 50% of patients with previous untreated infection. There is usually a three- to four-week delay between infection and the appearance of symptoms. These include fever, large joint polyarthritis with pain and tenderness, pancarditis (aortic and mitral regurgitation, heart failure, pericarditis), and chorea in 20% of patients (with full recovery after a few months). Erythema marginatum is the red rash seen on the trunk, arms and legs in 20% of patients. Subcutaneous nodules over the elbows, knees, wrists, ankles and Achilles tendon last for a few weeks.
Acute rheumatic fever and erythema marginatum in an adult patient
Published in Baylor University Medical Center Proceedings, 2022
Sonali Batta, Hannah Pederson, Karen B. Brust, Katherine H. Fiala
Upon hospital admission, bilateral lower-extremity chorea movements were observed, and her C-reactive protein (CRP) level was elevated (3.7 mg/dL). No abnormalities were seen on transthoracic echocardiogram or electrocardiogram. Skin biopsy results supported erythema marginatum. Given our patient’s elevated ASO titer, erythema marginatum, migratory polyarthralgia, chorea, fever, and elevated CRP, the diagnosis of ARF was established. She began intravenous ceftriaxone for 10 days, followed with daily azithromycin for the next 5 years. The patient was discharged with resolution of her symptoms.