Osler nodes and Janeway lesions
What do Osler nodes indicate?
Osler’s nodes result from the deposition of immune complexes. The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions. The nodes are commonly indicative of
subacute bacterial endocarditis
. 10–25% of endocarditis patients will have Osler’s nodes.
What do Osler nodes look like?
Osler nodes are
red-purple, slightly raised, tender lumps, often with a pale centre
. Pain often precedes the development of the visible lesion by up to 24 hours. They are typically found on the fingers and/or toes.
What is the difference between Osler nodes and Janeway lesions?
Osler’s nodes and Janeway lesions are similar and point to the same diagnostic conclusion. The only noted difference between the two is
that Osler’s nodes present with tenderness, while Janeway lesions do not
.
What are Janeway lesions?
Janeway lesions are named after Theodore Caldwell Janeway (1872–1917), an American professor of medicine. They are
nontender, erythematous or hemorrhagic macular or nodular lesions on the palms or soles
.
1
. They are commonly seen in acute endocarditis.
How long do Osler’s nodes last?
Osler nodes are small, usually raised, purplish red lesions, which are always tender, appear suddenly, and last
4 to 5 days
.
What is a Roth spot?
White-centered retinal hemorrhages
, also known as Roth spots, are retinal hemorrhages that can be seen in a variety of medical conditions. Roth spots are most commonly associated with infective endocarditis and have been detected in 80 percent of cases of subacute bacterial endocarditis.
How do you diagnose endocarditis?
Echocardiogram
. An echocardiogram uses sound waves to produce images of your heart while it’s beating. This test shows how your heart’s chambers and valves are pumping blood through your heart. Your doctor may use two different types of echocardiograms to help diagnose endocarditis.
What causes a splinter hemorrhage?
Splinter hemorrhages can occur with infection of the heart valves (endocarditis). They may be caused by
vessel damage from swelling of the blood vessels (vasculitis)
or tiny clots that damage the small capillaries (microemboli).
What is a heart infection called?
Infective endocarditis, also called bacterial endocarditis
, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. IE is uncommon, but people with some heart conditions have a greater risk of developing it.
In which condition we can see Osler nodes Janeway lesion and splinter haemorrhage?
Janeway lesions and splinter hemorrhages are a cutaneous sign of
infective endocarditis (IE)
. Janeway lesions are nontender, erythematous or violaceous maculae on the palms and/or soles that are also found in several noninfective diseases, such as systemic lupus erythematosus and myxoma.
What are the most common organisms that cause infective endocarditis?
Approximately 80% of infective endocarditis cases are caused by the
bacteria streptococci and staphylococci
. The third most common bacteria causing this disease is enterococci, and, like staphylococci, is commonly associated with healthcare-associated infective endocarditis.
Which Skin finding can be seen in a patient with infective endocarditis?
The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as
Osler’s nodes and Janeway lesions
. Osler’s nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes.
Do Janeway lesions go away?
Janeway lesions are irregular, nontender hemorrhagic macules located on the palms, soles, thenar and hypothenar eminences of the hands, and plantar surfaces of the toes. They
typically last for days to weeks
.
How common are Janeway lesions?
Janeway lesions (see Fig. 82-3) are painless, small, erythematous macules or minimally nodular hemorrhages in the palms or soles that occur in acute or subacute endocarditis—more commonly in the former, particularly if S. aureus is the cause, in which case they occur in
6% of patients
.
Do Janeway lesions hurt?
Janeway lesions are painless, macular, haemorrhagic lesions that occur most commonly on the palmar surface of the hands and feet. These lesions are
non-tender
, in contrast to the exquisitely painful Osler’s node.
