Acute Rheumatic Fever Without Pharyngitis: A Case Report.

An 18-year-old man presented with fatigue and polyarthralgia refractory to nonsteroidal anti-inflammatory drugs (NSAIDs). He had no history of sore throat or other upper respiratory symptoms. Reactive arthritis was initially suspected. However, persistent symptoms, fever, polyarthritis, a cardiac murmur, atrioventricular block, and an elevated antistreptolysin O titer (739 IU/mL) suggested acute rheumatic fever. He met the revised Jones criteria for acute rheumatic fever. Treatment with amoxicillin and corticosteroids rapidly resolved his symptoms and electrocardiographic abnormalities.