A 38 year old white man was admitted to the medical service of Dr. David J. Young at Woman's Hospital in Detroit on October 5, 1962. A diagnosis of subacute bacterial endocarditis was made. Roentgenograms of the chest showed enlargement of the heart in the region of the ventricles. The electrocardiogram was normal.On examination of the blood the hemoglobin was 12.4 gm; red blood cells 4,450,000; white blood cells 12,400. The differential count showed neutrophils 71; filaments 70; non-filaments 1; eosino phils 4; basophils 1; lymphocytes 19; monocytes 5. The first culture of the blood showed streptococcus viridans as did two subsequent cultures. The urine showed red blood cells 2-4 per high powered field and epithelium and mucous plus 1. It was otherwise normal.One million units of penicillin was given every three hours around the clock and 1 gm of streptomycin was given every 12 hours until it was stopped because of itching palms and wrists two weeks later.On October 21, sixteen days after admission, the patient devel oped severe pain in the left side of the neck and throat. This was intensified on swallowing. The left parotid gland became quite swollen, clearly outlined and exquisitely tender. The swelling and tenderness extended to the submaxillary region on that side. There were submucosal hemorrhagic areas in the left soft palate, buccal mucosa, floor of mouth and undersurf ace of tongue. The temperature was 102.6 and pulse 160 per minute. The patient appeared acutely ill. Penicillin was discontinued because of a skin rash.
