Abstract
A 20-year-old man was referred to us for assessment of a 1 year history of dyspnoea on exertion. At the age of 9 years, he had had two episodes of migratory polyarthritis suggestive of rheumatic fever. Cardiovascular examin ation showed a grade III/VI pansystolic murmur at the apex (see video). We noticed he had painless, correctable deformities of his hands and feet (fi gure A and B). He did not know his hands were deformed. His joints were enlarged but there was no evidence of active joint infl ammation or functional impairment, and no subcutaneous nodules. The erythro cyte sedimentation rate Lancet 2013; 381: 2108
Sign-in/Register to access full text options 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
