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Acute rheumatic carditis (ARC) is a significant disease in certain parts of the world. It can result from rheumatic fever (ARF), which is a systemic poststreptococcal inflammatory disease. In general, ARF occurs 1-6 weeks after Group A (beta-hemolytic) Streptococcus pharyngitis. The M protein, expressed by Streptococcus, has structural overlap with cardiac myocyte proteins like myosin, tropomyosin and vimentin as well as endothelial cell components. This broad overlap leads to antibody cross-reactivity, and a pancarditis, wherein the myocardium, endocardium, valves, and pericardium can be affected.

ARC manifests with a granulomatous reaction that can have fibrinous change to the center of the nodule. These nodular inflammatory foci are called Aschoff bodies/nodules (image below). Their appearance can look a little different depending on the phase of disease.

The inflammatory cells characteristic of these lesions (though not specific) are the Anitschkow cells (see lower half of the image below). These cells are a modified macrophage with an elongated profile, slightly basophilic cytoplasm and a serrated chromatin bar. These have commonly been referred to as a “catepillar” cell, although they have an “owl eye” look when cut in cross-section. Fusion of Anitschkow cells into multinucleated giant cells result in Aschoff cells.

SCVP Unknown Case 22

Anitschkow cell

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