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A retrospective clinical analysis of adult acute rheumatic fever was performed in 21 patients who were admitted in Srinagarind Hospital between 1984-1987. The mean age was 22 yr, sex ratio was F:M = 1:1.3 and most of them had previous rheumatic attcks. The most common major criteria was carditis (80%) and the second was arthritis (47%). Most of carditis patients had auscultatory murmurs (82%). Mitral regurgitation and mitral stenosis were equally found. The carditis could occur as the new carditis or on-top preexisting rheumatic heart diseases. All or the patients responded well to therapy and no one died in the acute phase of acute rheumatic attack. Other clinical manifestations, laboratory findings, antibiotic prophylaxis and relapse are discussed in details.