Abstract
BackgroundErythema marginatum is an uncommon presentation in children with acute rheumatic fever and it is one of the major criteria needed to make a diagnosis. It is seen in less than 10% of cases. It is also reported to be difficult to detect in black-skinned children. This is the first and only patient to present with the above since the inception of the unit about 14 years ago and also the first to be reported in Nigeria as far as the authors are aware, after a careful literature search; hence, we report this case based on the rarity of this symptom of acute rheumatic fever.Case presentationThis is a case report of O.E, a 12-year-old Nigerian girl who presented with features of acute rheumatic fever, and these features included the rare manifestation of erythema marginatum. She presented with generalized skin eruptions on the trunk and extremities, sparing the face, migratory polyarthritis, features of congestive heart failure and high grade continuous fever. The skin lesions consisted of papules, patches, plaques and polycycles with a reticular pattern having serpiginous and raised borders. Diagnostic investigations revealed elevated erythrocyte sedimentation rate of 83mm/h, anti-streptolysin O titer of 2020IU/L and echocardiography which showed thickened mitral valves with grade II mitral regurgitation and a mild pulmonary artery hypertension. The patient was treated with anti-inflammatory and anti-failure drugs and commenced secondary prophylaxis with benzathine penicillin. Skin eruptions resolved within 3 weeks of management and are currently on follow up.ConclusionsWe present the above to increase awareness on the possibility of acute rheumatic fever presenting with erythema marginatum in our region, to encourage early diagnosis of acute rheumatic fever to reduce morbidity and mortality from its sequel, rheumatic heart disease.
Highlights
Erythema marginatum is an uncommon presentation in children with acute rheumatic fever and it is one of the major criteria needed to make a diagnosis
We present the above to increase awareness on the possibility of acute rheumatic fever presenting with erythema marginatum in our region, to encourage early diagnosis of acute rheumatic fever to reduce morbidity and mortality from its sequel, rheumatic heart disease
A diagnosis of acute rheumatic fever was made using the Jones criteria. She had three major criteria and two minor criteria with evidence of recent streptococcal infection. She was Discussion Erythematous skin lesions have been associated with rheumatic fever as early as 1922 by physicians (Lehndorff and Leiner) who described that the lesions begin as a solid erythema which may be slightly raised and the erythema extends outwards while the skin in centre returns back to normal, the name erythema marginatum
Summary
We documented a case of ARF in an African child presenting with erythema marginatum. Erythema marginatum is a rare presentation of ARF and even more so in the black population. Cases of reported ARF itself is rare in developing countries despite being a disease of lowincome countries due to problems of overcrowding, poverty, poor health seeking behaviours and poor access to health care. The description of the rash is characteristic of EM. There is no specific treatment for EM as it can take days to years to resolve even after treatment of the other components of ARF. Physicians should be careful not to overlook this rare but useful clinical manifestation of ARF in African children
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
