It has long been known that bacterial endocarditis usually develops on valves which have been the seat of a preexisting deformity. Particularly is this true of the subacute type of the disease. Moreover, it has been well recognized that in the vast majority of instances the antecedent defect arises as a sequel of rheumatic fever and that less commonly it is the result of a congenital malformation. Yet no specific reference pertaining to the coexistence of bacterial endocarditis and syphilitic involvement of the aortic valve appeared in the literature until 1917, when Libman1 remarked on the infrequency with which subacute bacterial endocarditis attacks valves previously damaged by syphilis. He reiterated this observation in 1918,2 in 19203 and again in 1923,4 pointing out in striking contrast the comparably high incidence of both rheumatic and syphilitic aortic valvular disease per se. Unfortunately, the number of such cases observed by Libman is not
ROSENBERG DH. BACTERIAL ENDOCARDITIS AND SYPHILIS OF THE AORTIC VALVE. Arch Intern Med (Chic). 1940;66(2):441–464. doi:https://doi.org/10.1001/archinte.1940.00190140149008
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