Cardiovascular diseases are a chief cause of sudden death. Rheumatic Heart Disease (RHD) exists as a hidden burden in developing countries. It occurs as a sequelae to Rheumatic Fever caused by Group A β Hemolytic Streptococcus. Despite the existence of antibiotics and prophylaxis by Penicillin it is still prevalent. A 33 year old male was found unresponsive in his house and was later declared dead. He had a history of abdominal pain for the past 6 months for which he was on medication. There was no other relevant family and past history. He had no history of alcohol intake or smoking. Complete medico legal autopsy was done and confirmed to be RHD. RHD is an “iceberg” disease which is still prevalent in developing countries. A cross reaction between foreign antigen and cardiac proteins leads to formation of autoantibodies causing autoimmune reaction. Mitral valve is commonly involved. RHD diagnosis can be established using Jones criteria during clinical examination. RHD still exists despite use of advanced antibiotics and Penicillin prophylaxis and needs to be therefore considered as a diagnosis of sudden death of young adults.

Keywords: Caterpillar Cells; Sudden Death; Rheumatic Heart Disease.