ArticlesAschoff Bodies in an Operatively Excised Mitral Valve
Section snippets
Case History
A 57-year-old Haitian man presented in the spring of 1992 with a 2- to 3-month history of increasing shortness of breath, episodic swelling of his extremities, and nocturnal dyspnea. These symptoms were related to a history of easy fatigability and infrequent, but recurrent, low-grade fevers for which he had received no specific treatment. He had no history of streptococcal pharyngitis, and his examination was negative for chorea, arthritis, or subcutaneous nodules. A murmur of mitral
Discussion
Since 1904, when Aschoff [3]initially described its histomorphologic characteristics, the granulomatous nodule bearing his name has been considered to be pathognomonic for the diagnosis of acute rheumatic fever 4, 5. As is well known, these nodules are most frequently seen in the myocardium, particularly in the posterior portions of the left atrium and left ventricle, as well as the ventricular septum, and rarely in papillary muscles 4, 6. A number of observers have commented on the paucity of
Conclusion
Most acute episodes of rheumatic fever do not produce valvular incompetence refractory to medical management and requiring urgent valve replacement [7]. This exceptional case, however, has afforded us the unique opportunity to examine the two other portions of the cycle described by Klinge: massive deposition of fibrinoid material and granuloma formation. It also suggests to us that the same myopericardial granulomas (Aschoff bodies) can, and do, occur in valve tissue during earlier stages of
Acknowledgements
The authors thank Ms. Donna Zibolowsky for preparing the manuscript and William C. Roberts, MD, Luther R. Mills, MD, John H. Crosby, MD, and John S. Golden, MD, for their technical assistance.
NOTE: Fig. 5 appears on the following page.
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