We describe a case of acute rheumatic fever (ARF) with rheumatic heart disease (RHD) in a 9-year-old boy. As the case presents, heart disease and social disadvantage are inextricably linked. Adverse social circumstances may predispose vulnerable populations to disproportionate RHD risk and hinder optimal treatments and outcome. It is important that clinicians explore social factors and are aware of those that increase risk for ARF and RHD to accurately detect the disease. Further, clinicians should consider opportunities for social advocacy to improve a patient’s social situation
