A Child With Heart Failure and Bumpy Lesions on the Back

A young child presented with fever and worsening dyspnea. They denied cough or chest pain. Physical examination revealed signs of heart failure and murmurs of mitral and aortic regurgitation. Additionally, multiple nodules were seen over the back and elbow, resembling subcutaneous nodules of acute rheumatic fever (Figure). Laboratory parameters revealed elevated anti–streptolysin O titers and erythrocyte sedimentation rate. Transthoracic echocardiography confirmed the presence of severe rheumatic mitral and aortic regurgitation. The patient was stabilized with medical therapy (penicillin and corticosteroids) for heart failure and currently awaits valve surgery.