title: [Fatal active rheumatic disease. Study of 13 necropsy cases].
abstract: OBJECTIVE
  To study the clinical features of a group of patients with fatal acute rheumatic fever (ARF).
  
  
  METHODS
  Thirteen patients with ARF, the ages ranged between 4.5 and 25 (mean 14) years. Eight patients were male. Patients were studied in two groups: group A of those 14 year-old or younger (8 cases), and group B of those older than 15 years (5 cases).
  
  
  RESULTS
  Clinical presentation was fever and severe heart failure in all patients. In group A, it was the first attack of ARF in 5 patients. The time elapsed between beginning of symptoms and hospital admission ranged between 10 and 90 (mean 40) days. Mitral insufficiency occurred in all patients. The blood leukocyte count was greater than 10000 per mm3 in six cases. Atrioventricular block occurred in one case. Valvular vegetations were detected on echocardiogram in 4 cases. Two patients received antibiotic therapy. Surgical treatment of the valvular heart disease was carried on in one patient. In group B, it was the first ARF attack in 2 cases, the time elapsed between beginning of the symptoms and hospital admission ranged between 4 and 60 (mean 21) days. Leukocyte count greater than 10000 por mm3 occurred in 4 cases. Atrioventricular block was diagnosed in one case. Valvular vegetations on echocardiogram were detected in 2 patients. In two cases, the treatment was antibiotic therapy. Three patients were operated on.
  
  
  CONCLUSIONS
  ARF may still be fatal, even in the first attack or in patients in the third decade of life. Other diagnoses are frequently considered, due to the intense clinical and laboratorial manifestations.
authors.affiliation: Instituto do Coração do Hospital das Clínicas, FMUSP, Div. Clínica, São Paulo.
authors.forename: L G
authors.initials: LG
authors.lastname: Velloso
authors.forename: A J
authors.initials: AJ
authors.lastname: Mansur
authors.forename: M
authors.initials: M
authors.lastname: Grinberg
authors.forename: R V
authors.initials: RV
authors.lastname: de Assis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D012214:Rheumatic Heart Disease / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000628:therapy
vernacular_title: Doença reumática ativa fatal. Estudo de 13 casos de necrópsia.