About Endocarditis lenta with multiple septic skin lesions

One of the most permanent and very important features in the clinical picture of endocarditis lenta is, as you know, a tendency to embolism in various organs. Emboli can be carried by the blood stream into various organs: the spleen, kidneys, brain, etc., as a result of which a complex symptom complex with the participation of a number of organs is obtained, which is so characteristic of the clinical picture of protracted septic endocarditis. Embolism in any organ and the symptoms caused by it are often the cause of those complaints with which the patient first goes to the doctor, but often embolism in the organs important for life, for example, the brain, serves as the last blow that interrupts the life of these patients. From numerous works devoted in recent years to the etiology, clinic and pathological and anatomical picture of endocarditis lenta (Hess, Stahl, Zimnitsky, Nevyadomsky, Mindlin, Th. Horder, etc.), it can be seen that embolism in the spleen and kidney is most often observed, less often into the brain, limbs, retina and very rarely into the skin. In this case, the participation of the skin in the picture of the disease is reduced mainly to the presence of hemorrhages, which are an essential symptom of this clinical form. These hemorrhages in the skin and mucous membranes are closely related to the toxic changes in the vessels present in this disease, which entail their slight vulnerability (Zimintsky, Strazhesko, Skulsky, Mindlin), and do not depend, as was previously thought, on bacterial emboli (Stahl ). Real septic metastases with the formation of multiple purulent foci in the skin itself are evidently extremely rare. At least, in the literature available to me, I could not find a single such case. In view of this, we observed in the clinic prof. Luria's case of multiple septic skin lesions in endocarditis tenta is, as it seems to us, of known clinical interest.