Question

A 34 year old female presenting to the OPD with migratory arthritis and examination revealed a pan systolic murmur. ECHO was performed which is suggestive of mitral regurgitation. Biopsy image is provided showing characteristic nodules in heart muscle. Diagnosis will be?

• A. Infective endocarditis
• B. Rheumatic heart disease
• C. SABE
• D. Cardiac failure

Hint:

The characteristic biopsy finding in this condition shows Aschoff bodies with Anitchkov cells.

Answer 1

The Correct Option is B

Step 1: Analyse the clinical features. The patient has migratory arthritis (polyarthritis moving between joints), a pan-systolic murmur with ECHO showing mitral regurgitation, and is a young female. This clinical picture is consistent with rheumatic fever and its cardiac complication.

Step 2: Interpret the biopsy. The biopsy of heart muscle shows characteristic nodules. In rheumatic heart disease, the pathognomonic finding is the Aschoff body (Aschoff nodule). Aschoff bodies consist of a central zone of fibrinoid necrosis surrounded by Anitchkov cells (caterpillar cells / Aschoff cells) and lymphocytes. These nodules result from granulomatous inflammation in the myocardium.

Step 3: Eliminate other options.
- Infective endocarditis: Caused by bacteria; vegetations on valves, not Aschoff bodies on biopsy.
- SABE (Subacute Bacterial Endocarditis): Would show bacterial vegetations, not Aschoff nodules.
- Cardiac failure: A functional state, not associated with Aschoff body formation.

Conclusion: Migratory arthritis + mitral regurgitation + Aschoff bodies on biopsy = Rheumatic Heart Disease.