Rheumatic fever

Question 1

What is rheumatic fever? Which organs are involved?

Answer 1

• Rheumatic fever is a systemic, non-suppurative inflammation of organs in the body, after a streptrococcal infection with B-hemolytic streptococci.
• The organs involved include the heart, joints, brain, skin and kidney

Question 2

What are the categories of rheumatic diseases?

Answer 2

• rheumatism
• rheumatoid arthritis
• ankylosing spondylitis
• systemic lupus erythematosus (SLE)
• systemic sclerosis (scleroderma)
• dermatomyositis
• nodular polyarteritis

Question 3

Long-term rheumatic fever can go on to cause pancarditis (all 3 layers of the heart are affected), what is a key feature, histologically speaking, of pancarditis?

Answer 3

Aschoff bodies/nodules are a key feature of RF pancarditis.

Question 4

What are Anitschkow cells?

Answer 4

Anitschkow cells are cardiac histiocytes found in RF pancarditis

Question 5

1. How can rheumatic fever affect the skin adn what are these conditions called?
2. What are the clinical manifestations?
3. Histologically, what is seen?

Answer 5

1. RF can cuase systemic sclerosis, affecting the skin (scleroderma) and fingers (sclerodactyly).
2. Clinical manifestations of scleroderma are:
   - tight, thickened, hardened skin
   - narrow lips

Clinical manifestations of sclerodactyly are:

• pointed fingertips + ulcers
• atrophy of terminal phalanges
• fingers partially bent permanently

3. Increased deposition of collagen + thin epidermis (loss of rete ridges)

Question 6

What does CREST syndrome stand for?

Answer 6

• Calcinosis cutis
• Raynaud phenomenon
• Esophageal dysmotility
• Sclerodactyly
• Teleangectasia

Question 7

2 types of scleroderma (systemic sclerosis) exist, what are they?

Answer 7

• diffuse sclerosis, affecting all skin and possibly visceral structures
• CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangectasias)

Question 8

What is Raynaud’s disease?