STAR complexes: febrile illnesses associated with sore throat, arthritis, and rash

Between January 1990 and February 1991 we evaluated the cases of 20 patients for a symptom complex consisting of Sore throat, elevated Temperature, migratory Arthritis, and a pruritic urticarial Rash (STAR). The patients ranged in age from 3 1/2 to 48 years; most were from central Texas. Duration of illness varied from 2 weeks to longer than 1 year. Results of laboratory studies included the following abnormal findings: elevated erythrocyte sedimentation rate, leukocytosis, anemia, and thrombocytosis. Eleven of 18 (61%) patients had low antinuclear antibody titers. HLA-A2 was noted in 8 of 10 (80%) of those tested. Test results were positive in eight cases for IgM antibodies to parvovirus and in six cases for IgM antibodies to rubella, suggesting that these entities may represent an underdiagnosed cause of STAR complex. In six cases no specific cause of disease was found; these cases may be attributable to other infectious agent(s) yet to be identified. Here we present a description of the cases, a discussion of the differential diagnosis, and an evaluation of STAR complex.