Urticarial eruption associated with rheumatic fever in a child

The classic description of erythema marginatum is of a few asymptomatic ery thematous patches or plaques with a characteristic central clearing which m ay coalesce and develop a polycyclic configuration. We report a boy with a urticarial eruption without the classic lesions of erythema marginatum in w hom the diagnosis of rheumatic fever was subsequently made. Histology of th e urticarial lesions revealed a mixed, superficial, perivascular infiltrate with prominent eosinophils. Rheumatic fever should be considered in childr en with fever and urticaria-like eruptions even in the absence of the class ically described erythema marginatum.