Rheumatic fever—a vignette

Description: A 12-yr-old boy presented with 7 weeks of arthralgia, affecting the knees, cervical spine and small joints of both hands, and pain in the palms of both hands with reduced flexion of the second, third and fourth fingers.
He was initially apyrexial but subsequently developed a temperature of 38°C. He was pale with cervical lymphadenopathy. A nodule was noted over the lateral epicondyle of his left elbow. He had tenosynovitis affecting the palms, fixed flexion deformities of the second, third and fourth fingers of both hands and a reduced range of movement in the cervical spine. Pansystolic and diastolic murmurs were noted.
Rheumatic fever—a vignette R. L. Boon and E. Baildam Rheumatology 2005 44(9):1198