Cardiac necrobiotic (rheumatoid?) granulomas without arthritis. Report of two cases.

Cardiac necrobiotic lesions resembling rheumatoid granulomas were discovered in 2 patients without evidence of arthritis. Evidence from the literature indicates that pulmonary and subcutaneous nodules may occur before arthritis or before the appearance of the rheumatoid factor, and that cardiac lesions may occur early in the course of rheumatoid disease. Even in the absence of obvious arthritis and the rheumatoid factor, rheumatoid disease should be considered part of the differential diagnosis of acquired valvular heart lesions.