[Rapidly progressive aortic insufficiency in a female patient with rheumatoid arthritis]

In a 23-year-old woman with severe rheumatoid arthritis, a rapidly progressive aortic regurgitation (onset within 2 years) was observed. She had a high IgM rheumatoid factor titre and nailfold lesions. The differential diagnosis from infectious endocarditis was difficult. The patient's aortic valve was replaced with a St. Jude mechanical prosthesis. The aortic valve was tricuspid with thick sclerotic cusps and sterile ulcerations and vegetations on the left and right coronary cusps. Histopathologic examination showed hyaline degenerative changes and plasma cell infiltrates in the stroma of the cusps, associated with rheumatoid arthritis. In the literature, aortic regurgitation is associated with longstanding rheumatoid arthritis, subcutaneous nodules, a high IgM rheumatoid factor titre and (or) signs of vasculitis.