Acute rheumatic fever and rheumatic heart disease Quiz: Ace Your Exams

A 12-year-old boy presents to his primary care physician’s office for evaluation of joint pain. Parent reports that the patient developed pain initially in his elbows and wrists two days ago, and today he has pain in the bilateral knees. Parent states that she noticed a rash over the patient’s arms and torso. The patient has no significant past medical history and does not take any medication. On system review, the parent reports that the patient was sick with a sore throat about 2 weeks ago. Temperature is 38.4°C (101.1°F), blood pressure is 110/67mmHg, pulse is 111/min, respiratory rate is 20/min, and oxygen saturation is 98% on room air. A non-pruritic serpiginous rash with pale pink centers and raised red borders is on the upper extremities bilaterally and the torso. The patient is tachycardiac. The rest of the cardiopulmonary examination is within normal limits. There is evidence of bilateral knee effusions. Antistreptolysin O (ASO) titer is positive (reference range: negative). Which of the following is the most likely sequalae if this patient does not receive treatment for the likely underlying condition?  




 Reproduced from: Wikipedia