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Ms. s. is a 22-year-old secretary. she presents with fatigue, malaise, and a rash. on auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. she reports a recent severe sore throat. you suspect:

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The answer is acute rheumatic fever. Rheumatic fever is an autoimmune disease that may happen after a group a streptococcal throat contamination that sources inflammatory lesions in connective tissue. The symptoms of this kind of disease joints pain, joint stiffness, fatigue and hair loss.

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