Which ONE of the following is least likely to be found in a child dying of acute rheumatic fever?

The answer is D. The vegetations of acute rheumatic fever are usually small nodular aggregates of fibrin and platelets along the line of apposition of the valve cusps.

Aschoff bodies (A) are pathognomonic of rheumatic carditis. Pericarditis of an exudative fibrinous type (B) is present as rheumatic fever is a pancarditis; the 'bread and butter' appearance is due to the sticky fibrinous exudate. A recent sore throat due to infection by beta-haemolytic streptococci (C) is reflected in the raised ASO titre (E).