Janeway lesions are rare, non- tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler's nodes.https://en.wikipedia.org/wiki/Janeway_lesion
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- Signs and symptoms
Osler nodes and Janeway lesions are two rare but well-known skin manifestations of bacterial endocarditis. They have also rarely been described in systemic lupus erythematosus (SLE), gonococcaemia (gonorrhoea), haemolytic anaemia and typhoid fever. They are important as they may help in the earlier diagnosis of a serious medical disorder. Splinter haemorrhage in the proximal nail plate is also a sign of bacterial endocarditis.
Bacterial endocarditis is often divided into acute and subacute varieties depending on the speed that it progresses. The symptoms may include fever, lethargy, shortness of breath, chest pain or palpitations. These symptoms require prompt assessment and investigation by a physician.
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. They can occur at any time during the course of endocarditis (usually subacute) and last from hours to several days.
The lesions were first described by French Physicians as Nodosites Cutanees Ephemeres meaning Cutaneous nodules of short duration and by Dr Mullen of Hamilton. Parkes Weber later suggested that they are known as Osler nodes in recognition of the fact that Sir William Osler (1849-1919) had \\"first called attention to their full diagnostic importance\\". His first description of these lesions was in 1893. Sir William Osler, a Canadian-born Physician, wrote 1344 publications on a wide range of medical topics.
The underlying cause of the nodes has been debated since Osler first proposed micro-embolisation as a cause (this is the scattering of tiny particles around the bloodstream). Early reports favoured an allergic or immunological cause, but more recent reports have isolated bacteria from within the nodules.
A skin biopsy (histology) may reveal a neutrophilic vasculitis (inflammation of blood vessels) affecting the glomus apparatus of the ends of the fingers, or microabscess formation without evidence of vasculitis. It has been postulated that early biopsies show bacteria within the microabscesses and as time progresses, the nodes become sterile and hypersensitivity vasculitis or small vessel vasculitis develops, mediated by the immune system. A careful search for endocarditis is made. This includes multiple blood cultures, other blood tests, urine tests, ECG, chest X-ray, and an echocardiogram (heart ultrasound scan). The diagnosis may be elusive. A skin biopsy may be helpful to confirm the diagnosis of the Osler nodes.
Treatment of Osler nodes is aimed at the bacterial endocarditis and involves intravenous antibiotics and sometimes valve surgery.
Janeway lesions are rare, non- tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler's nodes.
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Janeway lesions are macular, non-painful, erythematous lesions on the palms and soles (Figure 13-10a). Osler's nodes are painful, violaceous nodules found in the pulp of fingers and toes (Figure 13-11). Roth spots are exudative, edematous hemorrhagic lesions of the retina (Figure 13-10b).
Oct 20, 2018 · In simple terms, Janeway lesion is a collection of pus within the tissues of the body with marked localized death of living tissue and inflammatory filtrate not involving the epidermis. The Janeway Lesions are distal, flat, eccchymortic and painless. They got the name from Edward Janeway (1841-1911).
Janeway lesions are one of the stigmata of infectious endocarditis. They are irregular, erythematous, flat, painless macules on the palms, soles, thenar and hypothenar eminences of the hands, tips of the fingers, and plantar surfaces of the toes; they rarely present as a diffuse rash, and are very rare in clinical practice.
- S M Divakaramenon, R Krishnan, R Chandni
Jul 13, 2010 · 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. They are usually seen with the acute form of bacterial endocarditis.
Feb 19, 2021 · A Janeway lesion is a skin abnormality that is associated with different diseases, including infective endocarditis and mycotic aneurysm. The lesions are usually located on the palms and soles, have small diameters, and are non-tender.
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.
Janeway lesions are one of the stigmata of infective endocarditis and are very rare in clinical practice. 1 The lesions are irregular, erythematous, flat, painless macules on the palms and soles. 2 They are usually seen with the acute form of bacterial endocarditis and typically last for days to weeks.