Subcutaneous Nodules in Acute Rheumatic Fever

A 15-year-old boy presented with a history of fever, migratory polyarthritis, and progressive dyspnea for 4  weeks. Physical examination revealed multiple, small, subcutaneous nodules over the scalp, extensor surface of the elbows, metacarpophalangeal joints, and dorsum of feet (Figure). Nodules were 0.5-1.5 cm in size, mobile, firm, nontender, and without any erythema or induration. Cardiovascular exam ination revealed raised jugular venous pressure, cardiomegaly, soft first heart sound, loud second heart sound, grade 4/6 harsh pan systolic murmur, and grade 2 mid-diastolic murmur at apex.

Source: The Journal of Pediatrics - July 9, 2019 Category: Pediatrics Authors: Amitabh Poonia, Priya Giridhara, Divya Sheoran Tags: Rediscovering the Physical Exam Source Type: research