Thirty-one adults with acute rheumatic fever were identified at Groote Schuur Hospital over a 10-year period. In keeping with other series, arthritis was the most common major criterion. However, unlike other series, cardiac involvement was a prominent feature. Two patients died and a further 4 required valve replacements as a result of the disease. This suggests that local factors are of importance in determining the morbidity of the disease and that physicians should consider acute rheumatic disease in adults who present with unexplained valvular disease or carditis.