Key result
A large endocardial rheumatoid nodule on the mitral valve caused an acute embolic stroke in a patient with seronegative rheumatoid arthritis, mimicking culture-negative endocarditis.
Case Report (n=1)
Large endocardial rheumatoid nodules can mimic infective endocarditis and cause embolic stroke, highlighting the need to consider this rare manifestation in rheumatoid arthritis patients with valvular masses.
Rheumatoid nodules warrant consideration in RA patients with embolic stroke and valvular masses; single case leaves open prevalence and management implications.
Rheumatoid nodules occur frequently in patients with rheumatoid arthritis and are the most common cutaneous manifestation of the disease. Although uncommon, rheumatoid nodules may also occur on cardiac valves, where they may be large and clinically significant. They may embolize and cause stroke. They may cause regurgitant murmurs, or they may result in valvular destruction. Echocardiographically, they may mimic an atrial myxoma or appear as a vegetation. We present a patient with seronegative rheumatoid arthritis who developed an acute embolic stroke; he had peripheral stigmata of infective endocarditis on physical examination and echocardiography revealed a mitral valve vegetation. We illustrate that these findings were due to a large, highly destructive mitral valve rheumatoid nodule. We review the literature on macroscopic endocardial nodules and emphasize their diverse clinical behavior.
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Vantrease et al. (2017) conducted a case report in Seronegative rheumatoid arthritis with acute embolic stroke (n=1). Endocardial rheumatoid nodule was evaluated. A large endocardial rheumatoid nodule on the mitral valve caused an acute embolic stroke in a patient with seronegative rheumatoid arthritis, mimicking culture-negative endocarditis.
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