Chinese Medical Journal

Chinese Medical Journal, 74: 54-61, January-February, 1956.

RHEUMATIC HEART DISEASE WITH CUTANEOUS VASCULAR ENDOTHELIOSIS

REPORT OF A CASE

YU CHEN-YU (44Eh#) Southwestern Hospital, Chungking

Local cutaneous vascular endotheliosis associated with rheumatic heart disease is not commonly seen in clinical practice. A case similar to that reported by Yen(1) was encountered at the Southwestern Hospital, Chungking. The patient had a high leukocyte count. The blood taken from the ear lobe, finger tip, face and arm contained a large number of macrophages (also known as histiocytes or clasmatocytes). During the period of observation, the macrophages gradually decreased in number and finally disappeared. The morphological characteristics of the macrophage also gradually changed to resemble the ordinary monocytes. The blood taken from the vein was normal and showed no macrophages. Our case is here reported.

CASE REPORT

The patient was a policeman, aged 28, native of Honan province. He had fever for two months in the summer of 1951 and later visited our outpatient clinic several times because of multiple migrating joint pain, frequent attacks of sore throat and dyspnea on exertion, Examination disclosed cardiac enlargement with a soft presystolic murmur over the apex, systolic murmur and diastolic murmur over the aortic area, and positive peripheral vascular signs of aortic insufficiency. The blood pressure was 104/? mm Hg. The blood Kahn test was positive; the patient admitted venereal exposure. The leukocyte count from the ear lobe was 7,050 per cu mm. The OPD diagnosis rested between syphilitic aortic disease and rheumatic heart with double valvular lesions. The patient received both sodium salicylate and antileutic treatment with penicillin injections, whereupon he felt better and the blood Kahn test turned to be negative.

He visited our clinic again on January 16, 1954, complaining of left upper abdominal pain that lasted nine days. Besides the positive cardiac findings he was found to have hepatosplenomegaly and tenderness over the spleen. The leukocyte count from the ear lobe was 150,000 per cu mm with 40 per cent macrophages. He was admitted on January 23, 1954 for further observation.

On admission the patient was found to be well developed and moderately well nourished, mentally clear and cooperative. Temperature 36.4 ©. Pulse 92. Respiration 23. There was no general glandular enlargement. No edema or jaundice. The external aspect of the ear lobes appeared normal. The jugular veins were