[Acute rheumatic fever (ARF) in an adult male].

Acute rheumatic fever (ARF) results from an autoimmune reaction following Streptococcus pyogenes-induced tonsilitis. It is a disease that has become uncommon in Germany and is rare in adults. Treatment recommendations are controversial in this age group. The case of a 29-year-old male with ARF following tonsillitis due to S. pyogenes treated with penicillin and amoxicillin/clavulanic acid in the setting outpatient is reported. After 6 weeks, the patient presented to hospital with elevated body temperature, painless red-livid skin lesions, and polyarthritis. Laboratory results showed elevated inflammatory parameters and antistreptolysin O titers. The Jones criteria for ARF were met. Symptoms improved rapidly under therapy with nonsteroidal anti-inflammatory drugs. Antibiotic prophylaxis was not given, but regular echocardiographic controls remained non-pathologic over 12 months.