A 7-year-old boy has acute rheumatic fever with a Jones criteria combination of carditis and polyarthritis. Which Jones criterion is he missing that would still allow diagnosis without another major criterion?
- A Erythema marginatum alone is sufficient
- B Sydenham's chorea alone with evidence of preceding GAS infection can diagnose ARF independently without requiring other major criteria ✓
- C Elevated ASO alone makes additional criteria unnecessary
- D Subcutaneous nodules alone are diagnostic
Correct answer: B. Sydenham's chorea alone with evidence of preceding GAS infection can diagnose ARF independently without requiring other major criteria
Explanation
Sydenham's chorea is a special exception in the Jones criteria — it can diagnose ARF as a standalone major criterion because chorea appears late (2–6 months after strep infection) by which time streptococcal antibody titers may have normalized and other manifestations resolved. The other four major criteria (carditis, polyarthritis, erythema marginatum, subcutaneous nodules) cannot individually diagnose ARF without at least one other major criterion or two minor criteria plus evidence of preceding GAS infection.
Reference: Ghai Essential Pediatrics, 10th ed.
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