The clinical diagnosis of acute rheumatic fever (ARF) may be challenging; however, a constellation of signs including new valvular insufficiency, cardiomegaly, and heart failure should readily prompt consideration of the diagnosis of rheumatic carditis. In addition, pulmonary findings are compatible with ARF, as associated pulmonary involvement may represent rheumatic pneumonia. We report the case of a young man with ARF and rheumatic pneumonia, a previously described but rare complication of ARF.