GLOMERULAR LESIONS OF SUBACUTE BACTERIAL ENDOCARDITIS

1. In most cases of chronic or subacute bacterial endocarditis due to the endocarditis coccus (Streptococcus viridans), there exists a distinctive pathological lesion in some of the glomeruli due to bacterial emboli. 2. The salient features of the pathological picture are first, the involvement of one or more loops of a variable number of glomeruli; secondly, the absence of any visible disease in the uninvolved glomeruli and in the uninvolved portions of affected glomeruli; and thirdly, the association in most of the bacterial cases of all the various stages of the glomerular process often seen in a single microscopical section. 3. The lesion does not occur in cases of acute endocarditis, and up to the present time it has been absent in cases of subacute bacterial endocarditis due to organisms other than the endocarditis coccus. 4. In a group of cases having vegetations that are typical of those in the active stage of subacute endocarditis (except that they are free from bacteria and healing or healed), the healed stage of this distinctive glomerular lesion is present, although it is less extensive than in the active bacterial cases. 5. These cases, therefore, are most probably examples of subacute bacterial endocarditis due originally to the endocarditis coccus, but in which the endocardial vegetations have become free from bacteria rather early in their course and are now healing or healed, as claimed by Harbitz and Libman. 6. During the active bacterial stage of the disease, if the glomerular lesions are not too numerous, the only symptoms produced will be an almost constant hematuria, usually demonstrable only microscopically. If the glomerular lesions are very numerous, symptoms resembling those of subacute hemorrhagic nephritis may occur and may even cause a fatal issue. If the glomerular lesions are very numerous but not sufficient to cause death, and the cardiac lesion should go on to healing, a contracted kidney, secondary to the glomerular lesion, may subsequently ensue and produce the typical symptoms and death. In such a case, the finding of the healed or healing lesion of subacute bacterial endocarditis will be accidental.