[Autopsy of a patient with rheumatic fever, who initially presented with acute respiratory failure]

A 59-year-old man was admitted to the hospital because of dyspnea, fever, and general erythema. He had hypoxemia on admission. Chest X-ray film showed diffuse reticulonodular shadows in both lungs. Chest CT showed a diffuse increase in density, predominantly in both lower lobes. The respiratory failure had rapidly progressed, and the patient died only 40 hours after admission. Autopsy revealed diffuse alveolar damage in the lung, and Aschoff's bodies in the cardiac muscle. Aschoff's bodies are specific for rheumatic fever, and consist of Aschoff's cells with owl-eye-like or caterpillar-like nuclei. We diagnosed this patient's condition as rheumatic fever because of the presence of Aschoff's bodies. Rheumatic fever is generally seen as a disease of younger people, and these patients rarely present with respiratory signs, but this case shows that we have to recognize the possibility of rheumatic fever in adults with respiratory signs and skin lesions.