21853              BACTERIAL ENDOCARDITIS

This woman aged 30 had a normal confinement 3 months before admission, although her doctor heard a heart murmur during the pregnancy. General malaise, lassitude, anorexia and night sweats had been present since delivery. Six weeks later a painful lump developed on the medial side of the right upper arm and another tender lump on the right 5th toe. On examination she was anaemic with a sallow complexion. There was an erythematous rash on the left ankle and a soft systolic murmur was audible along the left sternal edge. The ESR was 32 mm, haemoglobin 10.6 g. and leucocytes 7600. Blood culture grew streptococcus viridans. She was treated with penicillin and streptomycin, but 18 days after admission she developed right facial weakness, nominal aphasia and dyslexia, with a right extensor plantar response. Brain scan confirmed an infarct in the left parietal lobe. She gradually improved, but a month later she suddenly became deeply unconscious with a fixed dilated right pupil and died. At postmortem there was a left parietal softening with supervening acute haemorrhage, and there was a vegetation on the mitral valve.

The specimen shows the heart opened to display this mitral vegetation which is flat and pale with a rather smooth surface. It lies on the line of closure of the valve. The valve leaflets and the chordae tendineae are not thickened and there is no gross evidence of previous rheumatism.