(? Anarthritic) Rheumatoid Pancarditis With Terminal Acute Hemorrhagic Gastroenteropathy

In 1941 Baggenstoss and Rosenberg1found a high incidence of cardiac lesions in their pathological analysis of 25 cases of rheumatoid arthritis, the majority of which were interpreted as being identical to rheumatic heart disease. It is only in later publications2-5that rheumatoid heart disease emerged as a distinct entity, not attributable to previous rheumatic fever. Most lesions were nonspecific and consisted of valvular scarring, myocardial chronic inflammation, or healed pericarditis. They occurred in one third of autopsied rheumatoid patients. Rarely a pathognomonic rheumatoid lesion was found in the heart, made up of a central core of fibrinoid necrosis with peripheral palisading by histiocytes, identical to the subcutaneous rheumatoid nodule. Previous reports have all emphasized the presence of severe and longstanding arthritis. Therefore when heart disease becomes manifest without a background of typical rheumatoid polyarthritis, one does not seriously consider rheumatoid carditis in the differential diagnosis. In this