Articles
Aschoff Bodies in an Operatively Excised Mitral Valve

https://doi.org/10.1016/S1054-8807(96)00114-7Get rights and content

Abstract

Aschoff bodies are granulomatous lesions believed to be pathognomonic of rheumatic fever. Most histologic descriptions have been limited to locations adjacent to or within the myocardium. Aschoff bodies within valves are uncommon findings. We report a case showing the typical granulomas in an excised mitral valve. We suggest that Aschoff bodies can, and do, occur in valve tissue during acute rheumatic carditis and that structural differences between valves and typical intramyocardial locations, variations in frequency and strength of individual infections, individual host responses, and time intervals between infection and histologic examination often obscure their findings in valves.

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.

References (15)

There are more references available in the full text version of this article.

Cited by (4)

View full text