Chinese Medical Journal

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RHEUMATIC HEART DISEASE WITH VASCULAR ENDOTHELIOSIS 61

started on February 2, the decline in the white count and the percentage of the macrophages had already begun. The blood picture had become normal at the end of February and yet the symptoms of endocarditis were still present and the bone marrow culture was still positive on April 10. The change of the blood picture could not possibly be related to the splenic infarction because the patient had a rapidly enlarged and tender spleen in early March, long after the blood picture had become normal. As the nature of endotheliosis is still not fully understood, it is hard to say whether or not it can be considered as one of the complicated clinical manifestations of the rheumatic disease. :

SUMMARY

A case of rheumatic heart disease with subacute bacterial endocarditis is reported. During the course of observation the patient was found to have high leukocytosis and large numbers of marcrophages in the blood smear taken from the ear lobe. Macrophages were also demonstrated in the blood taken from the. finger tip, face and arm. The endotheliosis observed was apparently not related to the subacute bacterial endocarditis or to the splenic infarction. Whether it is one of the complicated clinical manifestations of the rheumatic disease is not certain.

REFERENCES 6 1. Yen, L. C., Local cutaneous vascular endotheliosis; report of a case, Chinese J. Int. Med. (in Chinese) 2:27-29, 1954.

2. Wintrobe, M. M., Clinical Hematology, 3rd ed., pp. 190-191, London, Kimpton, 1951.

3. Valedman, V. A., Rheumatic vascular endotheliosis and the ‘cupping test’, Chinese J. Int. Med. (in Chinese) 1:196-199, 1953.