Title Rheumatic fever.pdf ✅

Rheumatic Fever Mai Galal Elshenoufy Lecturer of Internal Medicine, Faculty Of Medicine, Cairo University
Clinical description • An immune-mediated inflammatory disease that occurs in the children and adolescents following pharyngitis or scarlet fever with group A beta hemolytic streptococci. • It affects the heart, skin, joints and CNS. • This is thought to develop because of an autoimmune reaction triggered by molecular mimicry between the cell-wall M protiens of the infecting streptococcus pyogenes and cardiac myosin and laminin. • The condition is not due to direct infection of the heart or the production of a toxin.

Pathology Acute rheumatic fever: • Aschoff bodies often develop in the myocardium and other parts of the heart. • Fibrinous nonspecific pericarditis, sometimes with effusion, occurs only in patients with endocardial inflammation and usually subsides without permanent damage. • Characteristic and potentially dangerous valve changes may occur. Acute interstitial valvulitis may cause valvular edema. Chronic rheumatic heart disease • Valve thickening, fusion, and retraction or other destruction of leaflets and cusps may occur, leading to stenosis or insufficiency. • Similarly, chordae tendineae can shorten, thicken, or fuse, worsening regurgitation of damaged valves or causing regurgitation of an otherwise unaffected valve. Dilation of valve rings may also cause regurgitation. Skin involvement: • Subcutaneous nodules show certain features resembling Aschoff bodies, but no characteristics distinguish the nodules from those of RA. Erythema marginatum has no specific histopathologic lesions. Arthritis: • Fibrinous exudate and sterile effusion with no erosions or pannus formation.