A case of Erythema Marginatum

A report describes a case of a healthy 3-year-old female child who presented with a 1-month history of fevers and rash. Examination revealed well-defined lesions with serpiginous margins that involved the back and lower extremities. 

The child was also diagnosed case of contact dermatitis, for which she received a topical glucocorticoid without improvement. The examination also revealed arthritis in her left ankle and right knee. 

Laboratory tests revealed normal complete blood counts and an erythrocyte sedimentation rate of 40 mm/h. She was found positive for the rapid streptococcal antigen test. 

Her electrocardiogram revealed a prolonged PR interval and a normal echocardiogram. Her antistreptolysin O and anti-DNAse B titers were heightened; thus, she was diagnosed with acute rheumatic fever (ARF). 

The child received intramuscular penicillin G benzathine and aspirin treatment, which resolved her arthritis and rash and normalized her inflammatory markers over the following six weeks. She also received secondary prophylaxis with intramuscular penicillin G benzathine every four weeks.

Vijayan V, Sukumaran S. Erythema Marginatum. The Journal of Pediatrics. 2023;258. DOI:https://doi.org/10.1016/j.jpeds.2022.12.038