Autoimmune reaction triggered by strep infection, affecting multiple organs
Risk Factors
Age 5-15
Occurs 2-3w after strep pharyngitis
Found most commonly in Africa, India, Middle East, South America
Symptoms
Relatively uncommon process assoc w/fever, fatigue
Acute/abrupt onset
Inflammatory arthritis of large joints typically (e.g. knees, ankles, elbows, wrist), which migrates (present in one area for few weeks, then moves to next)
Chest pain, SOB (pan-carditis)
Erythema marginatum (< 10% of cases)→ erythematous annular eruption
Painless sub-cu nodules
(Syndenham's) chorea (in 30% of cases)→ purposeless, spontaneous movements of limbs and torso, facial grimaces; emotional lability
Long term risk of mitral or aortic valve dz (later development of murmurs and heart failure)
Physical Exam Findings
Pericardial rub
Affected joint(s) are warm, red, pain w/movement
Choreaform movements
A few, small, painless sub-cutaneous nodules, typically over boney prominences or extensor tendons, often symmetric
Bright pink, erythematous, blanching, non-puritic macules and papules on trunk/limbs