Acute rheumatic carditis causing sudden death

Area of Science:

• Cardiology
• Pathology
• Rheumatology

Background:

• Sudden cardiac death (SCD) is a critical concern, particularly in young individuals during physical exertion.
• Rheumatic heart disease (RHD) is a significant cause of acquired valvular heart disease globally.
• Acute rheumatic fever (ARF) can lead to chronic rheumatic heart disease, but acute inflammatory cardiac involvement is less commonly recognized as a cause of SCD.

Observation:

• An 18-year-old male military recruit experienced sudden cardiac death during basic training.
• Autopsy revealed acute rheumatic mitral valvulitis and extensive myocarditis.
• Microscopic examination showed multiple Aschoff bodies in the ventricular myocardium.

Findings:

• The autopsy findings of acute rheumatic mitral valvulitis and myocarditis are not commonly reported causes of SCD in young adults.
• The presence of Aschoff bodies confirmed active rheumatic inflammation affecting the heart.
• The deceased had no prior history of acute rheumatic fever.

Implications:

• This case suggests that acute rheumatic valvulitis and myocarditis should be considered in the differential diagnosis of unexplained SCD, even without a prior history of ARF.
• Further research is needed to understand the incidence and mechanisms of SCD associated with acute rheumatic cardiac inflammation.
• Raising awareness among clinicians and pathologists about this rare presentation of RHD is crucial for accurate diagnosis and potentially preventative strategies.