Erythema marginatum is a non-pruritic, pink eruption that is present in cases of acute rheumatic fever. It is a consequence of pharyngeal infection with group A streptococcus, usually in childhood. In some cases, rheumatic fever can lead to valvular damage, often mitral stenosis. The characteristic murmur of MS is: late, rumbling diastolic murmur that changes with respiration as describe in clinical case above. Jones criteria are used to diagnose acute rheumatic fever: Major Criteria: J O JOINTS Large joint - Migratory polyahritis Nonerosive ahritis (Painful): TX: - Aspirin N- Subcutaneous nodule: Painless nodule on extensor E- Erythema marginatum S- Sydenham chorea (late stage, involve basal ganglia) C- Carditis (pan carditis) Minor criteria: fever, ahralgia, elevated ESR, leucocytosis, evidence of hea block and evidence of streptococcal infection such as ASO. Erythema migran: Bulls eye red rash with central clearing: present in early stage of lyme disease caused by borrelia burgdorferi which is transmitted by infected black legged tick. Lyme disease can cause hea block but it is not associated with MS. Erythema multiforme: severe skin eruption. Steven-Johnson syndrome is major form of erythema multiforme. Erythema multiforme does not accompany Rheumatic fever. Janeway lesion: small erythematous lesion on the palms or soles that result from emboli from valvular vegetation in case of acute bacterial endocarditis.