Bacterial endocarditis superimposed on syphilitic aortitis and valvulitis: A clinicopathological study with 5 case reports

Five cases of proved syphilitic endocarditis or aortitis, with superimposed bacterial vegetations, have been presented. In none of the cases were both diagnoses made clinically. In all five cases the blood Wassermann and Kahn reactions were positive. In four cases blood cultures were positive, and in the fifth case Streptococcus viridans was grown from the vegetation on the heart valve.Streptococcus viridans was recovered in four of the cases and Streptococcus hemolyticus in the remaining case. In three of the cases embolic phenomena were prominent, and in two the mesenteric vessels were involved. In one case there were multiple saccular mycotic aneurysms of the membranous septum and aortic cusps. In another case a fairly characteristic syphilitic aortic valvulitis and aortitis were associated with a typical rheumatic involvement of the mitral valve.The diagnosis of syphilitic aortitis and valvulitis does not exclude the possibility of superimposed bacterial involvement, as shown by the above cases, although the lesion undoubtedly is rare. This diagnosis should be considered clinically whenever there is a combination of sepsis of undetermined origin, a positive Wassermann reaction, and evidence of aortic insufficiency or aortitis, without evidence of previous rheumatic infection.