Synonyms
- Eritema marginatum rheumaticum
- Erythema annulare rheumaticum
Mechanism:
- Infection with group A beta-hemolytic streptococci
- → Antigenic mimecry to M protein
- → autoimmune response causing rheumatic fever
Rheumatic fever diagnosis
- (2 major or 1 major and 2 minor)
- Major criteria (JONES)
- Joints - migratory polyarthritis
- O - heart - carditis or valvulitis
- N - nodules - subcutaneous nodules
- E - erythema marginatum
- S - Sydenham corea
- Minor criteria: fever, polyarthralgia, elevated acute phase reactants, prolonged PR
Apresentação clínica
- Erythematous macules that spread peripherally
- Migratory annular/polycyclic erythematous arrangement
- Leaves pale or lightly pigmented areas
- Lesions lack scale
- Trunk, axillae and proximal extremities
- Last a few hours to a few days
- Usually seen with carditis and before arthritis
- Subcutaneous nodules
- Associated with chronic rheumatic fever
- On bony prominences
Pathology
- Interstitial and perivascular neutrophilic infiltrate without vasculitis
Epidemiology
- More common in children
- 3% of patients with untreated strep get rheumatic fever
- <10% of patients with acute rheumatic fever develop erythema marginatum
- Subcutaneous nodules may be seen with chronic rheumatic fever
Treatment
- None needed
- Salicylates used for arthritis
- Salicylates or corticosteroids used for carditis
- Antistreptococcal prophylaxis
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