In Reply. — The single patient with rheumatic nodules described in our article and referred to by Dr Marshall had an interesting clinical course. Believed by many observers of our outbreak to have the most severe case of acute rheumatic fever, he presented with fever, severe polyarthritis, carditis, and rheumatic nodules. He had been receiving ibuprofen prior to admission to the hospital, but compliance was uncertain. On admission he began ibuprofen therapy, 800 mg every 8 hours. As noted in his hospital record, he had a dramatic improvement within 48 hours of admission, with defervescence and markedly decreased joint pain, swelling, and stiffness. This rapid response was typical of the other nine patients, all of whom were treated with aspirin. Several days into his hospitalization the house staff, now convinced the diagnosis was acute rheumatic fever, considered a change to aspirin. However, the rheumatology staff physician (Dr Marshall) recommended the