Immunologic mechanisms have been implicated in the endocarditis, myocarditis, and arthritis of acute rheumatic fever. However, pericarditis, a major manifestation of acute rheumatic fever with a clinical incidence of 5-lo%, has not been studied. We have evaluated a patient who had this febrile disease with arthritis and pericarditis. Pericardial tissue showed extensive deposition of IgG, IgM, and C3 both on the pericardial surface and within the walls of pericardial blood vessels. Our findings of immunoglobulins and complement within the inflamed pericardium suggest an immune-mediated mechanism for the pericarditis of acute rheumatic fever.Immunologic mechanisms have been suggested to be important in the pathogenesis of acute rheumatic fever (1). Immunofluorescent studies have shown that sera of patients with this disease are reactive with constituents of cardiac myofibers and with smooth muscle of vessel walls. In addition, circulating antiheart antibodies have been found in 25-81% of patients with acute rheumatic fever (2). Although it has been assumed that the pericarditis of this febrile disease is also immunologically mediated, this has not been documented. Inflammation of the pericardium has been observed after foreign serum vaccine injections or drug reactions in the postpericardiotomy and the postmyocardial infarction syndromes and in systemic lupus erythematosus (3-5).Immunologic mechanisms are believed important in the pathogenesis of pericarditis in these disorders, and antiheart antibodies have been documented in some of these patients. However, immunofluorescent studies on the pericardium in acute rheumatic fever have not been carried out.We have had the opportunity to study a patient with this febrile disease complicated by pericarditis and pericardial effusion. Tissue obtained at surgery was studied using immunofluorescent techniques. The results are reported in this paper.
PATIENT AND METHODSCase report. A 23-year-old black man with a history of acute rheumatic fever was admitted to the Salt Lake City VA Medical Center on March 8, 1980, for evaluation of fever, migratory polyarthritis, and a heart murmur. He was diagnosed as having acute rheumatic fever with carditis (aortic insufficiency) in 1977. At that time, he was started on prophylactic penicillin, but compliance was poor.Two weeks before his admission to this hospital, he developed a sore throat, which resolved spontaneously in 7 days. Three days before admission, he had fever and migratory joint pains at the wrist, elbows, shoulders, knees, hands, and feet. On examination, he was obese and complained of marked joint pains. Vital signs revealed a blood pressure of 150/80 mm Hg; pulse, 8Wminute; respirations, 26/rninute; and temperature of 38°C. His pharynx was congested; the chest was clear. Cardiovascular examination revealed a normal jugular vein pulse, an S4 gallop, a grade
RHEUMATIC PERICARDITIS
1055IVVI systolic ejection murmur at the left sternal border radiating to the apex, and a soft diastolic blow grade II/VI well localized at t...
