Rheumatic fever in the adult

Abstract

The clinical manifestations of acute rheumatic fever were evaluated in a study of 35 adult patients. Migratory polyarthritis occurred in all but 1. None had chorea, erythema marginatum, or subcutaneous nodules. Carditis occurred in 8, manifested by pericarditis in 4 and by development of new significant murmurs in 4. Two patients died during their acute attacks, and 9 exhibited new valve damage on follow-up. The results of the study indicate that rheumatic fever represents a continuous spectrum from childhood to adulthood, in which the incidence of carditis, though diminishing, remains significant. In addition, cardiac involvement may occur de novo in the adult, resulting in permanent damage or even death. This would have important implications regarding penicillin prophylaxis.