Pseudorheumatoid subcutaneous nodules and the poststreptococcal state. A case report.

A 10-year-old girl with an acute illness fulfilling the Jones criteria for rheumatic fever is described. She had subcutaneous nodules, arthritis, an elevated ESR, and serologic evidence of a recent streptococcal infection. Her clinical course was benign and at ten weeks, the nodules disappeared, the joint pains had subsided, and the ESR was normal. Thus, there was little to support a diagnosis of rheumatic fever. We hypothesize that the patient had pseudorheumatoid subcutaneous nodules coincidental with poststreptococcal arthritis. A revision of the Jones criteria disallowing subcutaneous nodules as an independent major sign of rheumatic fever is proposed.