A 4-year-old white girl was entirely well until Jan 8, 1979, when her temperature was 104 F. Other symptoms included nasal congestion, slight cough, and pain in the right ear. On physical examination her right ear drum was moderately inflamed and bulging. Her tonsils were large and red, but no exudate was present. Tender anterior cervical lymph nodes, 2 x 2 cm, were palpable bilaterally. Her chest was clear. There was a grade 1/6 systolic murmur along the left sternal border (LSB) which had been heard on previous examinations and was thought to be innocent in nature. Her spleen was not palpable.