Medical records of patients discharged from Children's Hospital of Wisconsin from January 1980 to May 1988 who fulfilled the revised Jones criteria for acute rheumatic fever were reviewed. A total of 13 patients were hospitalized with a first attack of acute rheumatic fever during this period. Migratory polyarthritis was present in 92% of the patients and carditis in 62%. Mitral regurgitation was present in all cases of carditis. Only six patients (46%) had a history of a preceding streptococcal infection, half of whom were treated with antibiotics. While there is no evidence to support a new outbreak of acute rheumatic fever in Wisconsin, our data demonstrate that the disease is still prevalent within the eastern region of the state. Patients with Group A streptococcal pharyngitis must be identified and treated to prevent this disease from increasing in incidence.