Though syphilitic aortic valvulitis and vegetative bacterial endocarditis are well established separate clinicopathologic entities, the concomitant occurrence of the two processes on the same valve has been regarded as extremely rare,1 and relatively little has been written on this subject. In 1920 Libman2 remarked on the infrequency with which bacterial endocarditis attacked valves previously altered by a syphilitic process. Thayer's3 excellent monograph on infective endocarditis gives the impression that the cases of simultaneous syphilitic and bacterial aortic valvular involvement mentioned (i. e., 4 certain cases and 2 doubtful ones) are admitted reluctantly and with a skepticism that such combinations occur. Blumer,4 Gross and Fried5 and Levine6 likewise merely mention 1 case each but give no further details. Review of the literature has yielded only 11 proved cases.7 Despite this paucity of material, we have come to think that bacterial endocarditis engrafted on syphilitic aortic valves, though not nearly as common
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