Rash 

 Diseases such as Lyme disease and SLE which present with rash may be mistaken for ARF. Lyme disease presents with characteristic rash and arthritis (which appears 1 to 2 months after onset). Juvenile SLE is differentiated by typical skin rash, multiple organ involvement and presence of anti-nuclear antibodies.  

Diagnosis

Diagnosis of rheumatic fever is made on basis of various symptoms, signs and results of work up in a case of rheumatic fever (Table 1.2). According to the revised Duckett-  Jones criterier, the diagnosis is based upon two or more major clinical manifestations; or and major and two or more minor menifestations. In both cases evidence of previous streptococcal infection is required.   

                                                         Table  Work-up in a Case of Acute Rheumatic Fever
                                                           Blood                                        Leucocytosis, raised ESR. C-reative protien(raised)
                                                                                                            ASO titre (raised > 250 units)
                                                            Throat                                     Throat swab for beta haemolytic streptococci
                                                            Chest-X-ray                             Enlarged heart
                                                            ECG                                         Increased PR interval ( I degree heart block, rarely II and III                                                                                                                            degree heart block) if pericarditis-low   
                                                                                                           voltage,   T-wave inversion
                                                           Echocardiography                    For valve abnormality, cardiomegaly and pericar dial effusion