An outbreak of acute rheumatic fever in 23 patients was seen in northeastern Ohio in 1986, with polyarthritis (78%) and carditis (30%) the major manifestations. Results of a questionnaire completed by the parents of all 23 patients indicated that they were generally nonindigent, with good access to medical care, and from a nonurban setting. Records of inpatients with acute rheumatic fever were reviewed for the 10 years prior to 1986. The clinical manifestations in inpatients from 1976 to 1985 were not significantly different from those of inpatients seen during 1986. Similar outbreaks have been reported elsewhere, and physicians should be aware of a possible resurgence of classic acute rheumatic fever and ensure compliance with an adequate course of therapy for patients with streptococcal pharyngitis.