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In a patient with a documented nonejection systolic click and late systolic murmur, acute mitral insufficiency developed as a result of spontaneous rupture of mitral chordae tendineae. There was no evidence of previous endocarditis, rheumatic fever or congenital heart disease. The ballooning mitral valve syndrome has previously been considered relatively benign. Chordal rupture has been predicted, and presumptive cases have been alluded to by several investigators. This well documented report of such a complication casts further doubt on the benignity of the syndrome.

Since the advent of use of phenothiazine derivatives as “tranquilizing” drugs, physicians have become aware of the occurrence of severe contact dermatitis in response to administration or handling of certain members of this chemical group (1-3). In addition, clinical observations (4) of the course of jaundice in patients taking oral doses of tranquilizers of this group strongly suggest that other side reactions, notably chlor-promazine hepatitis, may well be allergic manifestations. Hepatitis, as well as agranulocytosis, has been accompanied by skin reactions, and the course of the liver sensitization and desensitiza-tion, studied in a group of patients on a protracted course of chl or promazine therapy, seems to indicate that a similar mechanism of drug sensitivity is involved (5). A peculiar type of retinal toxicity, which also seems to have an allergic basis, has been reported with a phenothiazine drug (6).