Subacute Bacterial Endocarditis Presenting as Purpura

Abstract

PURPURA is a rare occurrence in the course of subacute bacterial endocarditis (SBE) but may be a prominent sign of this disease. This report concerns two patients with streptococcal viridans-type infections of the aortic valve, who presented with such striking purpura that the possibility of a primary coagulation disorder was seriously considered before the diagnosis of SBE was established. <h3>Report of Cases</h3> Case1.—The patient, a 57-year-old congenitally deaf white woman, was well until January 1964. Shortly following multiple tooth extractions she experienced weakness and malaise. She was found by a physician to be in mild congestive heart failure. In early February 1964, another physician found no evidence of heart failure but treated her with sulfisoxazole for hematuria. On March 3, 1964, she was admitted to Bellevue Hospital because of weakness and confusion. Physical examination revealed an emaciated woman with numerous purpuric spots on both legs and the anterior portion