Acute rheumatic fever case study

Clinical Summary
A 21-year-old male with sickle cell anemia had recurrent attacks of acute rheumatic fever beginning at age 14.

Mitral insufficiency and stenosis were present by age 16.

On prophylactic antibiotics, the patient had no evidence of recurrence until three weeks before his final admission, when an upper respiratory infection developed. A few weeks later he developed acute migratory polyarthritis. This was associated with rapid deterioration of cardiac function and death.

Autopsy Findings
At autopsy, the heart was enlarged (weighing 675 grams) especially the left atrium. Both the aortic and mitral valves showed fibrosis as well as the fresh, tiny verrucae characteristic of acute rheumatic fever.

Images
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology