Rheumatic fever: atypical presentation in an adult

A 38 year old Caucasian lady presented with a history of vague ill health, raised ESR and prolonged P-R interval on ECG. These features became normal within a week. Contrary to the usual presentation, this patient developed fleeting arthritis, one of the major diagnostic features of rheumatic fever, towards the end of her illness. It is important to recognise such variants of rheumatic fever, even in retrospect, for the sake of giving penicillin prophylaxis to prevent cardiac morbidity.