A case of acute aortic insufficiency due to severe rheumatoid arthritis, showing progression in two weeks

A 74-year-old woman with a history of myocardial infarction and severe rheumatoid arthritis on immunosuppressants was referred to our hospital because of nausea and tooth pain, but no abnormalities were detected on physical or laboratory examination. Two weeks after the first assessment, she was referred to our hospital again because of tooth pain and dyspnea. Her echocardiogram showed severe aortic regurgitation, which was not detected at the assessment 2 weeks previously. After the patient's congestive heart failure showed improvement, she underwent aortic valve replacement; the aortic valve leaflets were severely shrunken and thickened, without any evidence of endocarditis. Pathological examination of the leaflets showed infiltration of inflammatory cells into the valve leaflets. Therefore, rheumatoid arthritis needs to be considered as an important risk factor for acute valvular disease.