RHEUMATIC FEVER PNEUMONITIS: A CLINICAL AND PATHOLOGIC STUDY OF 35 CASES

Abstract

Cases (35) of rheumatic fever pneumonitis were studied at autopsy and the clinical features studied in retrospect. Presence of unusually severe respiratory distress which does not respond to supportive management and is not associated with cardiac or peripheral features of congestive heart failure suggests the diagnosis of rheumatic fever pneumonitis. Severe cough, chest pain, cyanosis, and hemoptysis, if severe and prolonged, are also highly suggestive as is high or prolonged fever in the absence of positive blood cultures. Such respiratory signs do not respond to salicylate therapy. Migratory physical signs of pulmonary congestion and consolidation in the absence of pleural effusion or other evidence of congestive heart failure are the usual findings. Clinical evidence of carditis is constant. Routine laboratory studies and ecg findings reflect the basic pattern of rheumatic fever and are of no special value in differential diagnosis. Chest X-ray findings are increased perivascular markings arising at the hilus and progressing to nodulation, confluence and massive consolidation with relatively clear apices and bases. Anatomic changes are reflected in the consequences of alveolar fibrinoid necrosis, focal hemorrhages, alveolar lining cell proliferation, organization of exudate, development of hyaline membranes, fibrinoid necrosis of bronchiolar lamina propria, and arteritis. Ante mortem recognition of rheumatic fever pneumonitis is a prerequisite for successful therapy.