Erythema marginatum, manifestation of acute rheumatic fever
Erythema marginatum is defined as a cutaneous finding associated with acute rheumatic fever (ARF), a sequel of throat infection by group A streptococci (GAS). Usually, acute RF occurs 3 weeks after infection. Erythema marginatum is a cutaneous finding and is associated with ARF. Typically, the lesion develops 7 days to months after the onset of streptococcal pharyngitis. Rarely in case of streptococcal skin infections. Erythema marginatum is reported in only 10% of cases of ARF. Although the fever is reported less commonly in developed countries, it continues to be a major concern.
Case study
This article describes the case of a 36-year-old man diagnosed with acute rheumatic fever with erythema marginatum. The previously healthy man presented with complaints of fever and pain in both shoulders and knees with a history of 1 month. 2 weeks before the onset of fever, the patient also suffered from a sore throat. Laboratory studies showed a white cell count of “13,800 per cubic millimeter (85% neutrophils), a C-reactive protein level of 26 mg per deciliter (reference value, ≤0.3), and an antistreptolysin O titer of 1478 IU per milliliter (reference value, <241)”.
Doctors further advised a transthoracic echocardiography which showed mild aortic regurgitation.
The patient was prescribed a nonsteroidal anti-inflammatory drug after which his fever and arthralgias abated. However, a week later, the patient returned with painless, nonpruritic, red annular macules on the upper limbs and abdomen. The rash further migrated and faded over the course of a few days and new lesions appeared. The patient was referred for skin biopsy, histopathological findings showed perivascular infiltration of lymphocytes and neutrophils in the dermis.
Based on these findings the patient was diagnosed with acute rheumatic fever with erythema marginatum. Erythema marginatum is a nonpruritic rash and one of the major criteria for diagnosis of acute rheumatic fever. Doctors prescribed the patient with amoxicillin for secondary prophylaxis of rheumatic heart disease. The rash abated 4 months after presentation, whereas antistreptolysin O titer decreased to 246 IU per milliliter 12 months after.
Source: NEJM
