Question

A 34 year old female presenting to the OPD with migratory arthritis and examination revealed a pan systolic murmur. ECHO was performed which is suggestive of mitral regurgitation. Biopsy image is provided showing characteristic nodules in heart muscle. Diagnosis will be?

• A. Infective endocarditis
• B. Rheumatic heart disease
• C. SABE
• D. Cardiac failure

Hint:

The characteristic biopsy finding in this condition shows Aschoff bodies with Anitchkov cells.

Answer 1

The Correct Option is B

Clinical scenario: Young female, migratory arthritis, pan-systolic murmur, mitral regurgitation on ECHO, biopsy showing characteristic cardiac nodules.

Diagnosis: Rheumatic Heart Disease (RHD)

Pathognomonic finding: Aschoff bodies (Aschoff nodules)

Composition of Aschoff body:
- Central zone of $fibrinoid\ necrosis$ (collagen degradation)
- Surrounding $Anitchkov\ cells$ (Aschoff cells / caterpillar cells) - activated macrophages with characteristic caterpillar chromatin
- Peripheral $lymphocytes$ and $plasma\ cells$

Pathogenesis: Group A beta-haemolytic Streptococcus infection triggers molecular mimicry. Antibodies against streptococcal M protein cross-react with cardiac myosin and valve tissue, causing autoimmune inflammation.

Jones Criteria Major features: Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules

Most common valve affected: Mitral valve (mitral regurgitation in acute phase)

\[\boxed{\text{Rheumatic Heart Disease}}\]