Urticarial Eruption Associated with Rheumatic Fever in a Child


Address correspondence to Hossein C. Nousari, M.D., Division of Dermatoimmunology, Johns Hopkins Medical Institutions, 720 Rutland Ave., Room 771, Baltimore, MD 21205, or e-mail: hnousari@welchlink.welch.jhu.edu.


Abstract: The classic description of erythema marginatum is of a few asymptomatic erythematous patches or plaques with a characteristic central clearing which may coalesce and develop a polycyclic configuration. We report a boy with a urticarial eruption without the classic lesions of erythema marginatum in whom the diagnosis of rheumatic fever was subsequently made. Histology of the urticarial lesions revealed a mixed, superficial, perivascular infiltrate with prominent eosinophils. Rheumatic fever should be considered in children with fever and urticaria-like eruptions even in the absence of the classically described erythema marginatum.