During the past few years, three patients have been admitted to the surgical service at Cook County Hospital with a diagnosis of acute appendicitis. All three underwent appendectomies, and in each instance the appendix was grossly and microscopically normal. Subsequent to laparotomy, a definite pericardial friction rub developed, and a diagnosis of rheumatic pericarditis was made.
The incidence of acute abdominal pain at the onset of rheumatic fever, particularly with acute pericardial involvement, is seen not uncommonly. The mechanism of its production is obscure, and its clinical recognition difficult. Geissinger1 recorded a case in a boy 5 years of age who had a sudden onset of abdominal pain with fever and vomiting accompanied by marked rigidity of the abdominal muscles. A laparotomy was done, and a normal appendix was found. On the fourth day postoperatively polyarthritis developed, and on the tenth day a typical pericardial friction rub was heard.