ACUTE BACTERIAL ENDOCARDITIS
This 19 year old female had a past history of rheumatic fever 6 years prior to presentation. She was quite well until 6 weeks before admission when she experienced a gradual onset of anorexia, lassitude, sore throat and weight loss. 3 weeks later she was confined to bed with a fever. Examination revealed a hypotensive female with infected tonsils. Cardiac hypertrophy was present, thrill being felt at the apex and in the pulmonary area. The spleen was palpable and signs were present at the left base. The joints were not swollen but both arms were painful on active or passive movement. Petechiae appeared the day following admission and following this there was steady deterioration and death.
The specimen is of heart sliced open to display the right ventricular cavity. The tricuspid valve shows massive yellow vegetations with partial ulcerative destruction of the valve and chordae. The vegetations have a roughened surface and appear to be of recent origin. Otherwise the heart appears normal. At necropsy recent pulmonary infarcts were found. This is an example of acute bacterial endocarditis. The responsible organism was Staphylococcus aureus which was cultured from both vegetations and spleen.