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Jul 24, 2023 · Osler nodes and Janeway lesions are cutaneous manifestations of endocarditis, a disease most commonly arising from a bacterial or fungal infection of the cardiac endocardium.[1] Osler nodes are tender, purple-pink nodules with a pale center and an average diameter of 1 to 1.5 mm.[2] They are generally found on the distal fingers and toes, though they can also present on the lateral digits ...
- Krishan Parashar, Steven Daveluy
- 2023/07/24
- 2021
- What Are Osler Nodes and Janeway Lesions?
- What Is Bacterial Endocarditis?
- Osler Nodes
- How Did Osler Nodes Get Their Name?
- What Is The Cause of Osler nodes?
- What Tests Should Be done?
- What Is The Treatment of Osler nodes?
- Janeway Lesions
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.
Bacterial endocarditis is an infection of the lining of the heart caused by various bacteria. It most often affects the heart valves. The bacteria gain access to the heart via the bloodstream; an infection elsewhere in the body may or may not be apparent. While some bacteria can cause infection in normal heart valves, bacterial endocarditis more co...
Osler nodes are red-purple, slightly raised, tender lumps, often with a pale centre. Pain often precedes the development of the visible lesionby 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 nodulesof 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 importan...
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 neutr...
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 ultrasoundscan). The diagnosis may be elusive. A skin biopsymay be helpful to confirm the diagnosis of the Osler nodes.
Treatment of Osler nodes is aimed at the bacterial endocarditis and involves intravenous antibioticsand sometimes valve surgery. The skin lesions tend to heal spontaneously without scarring.
In contrast to Osler nodes, Janeway lesions are non-tender, often haemorrhagic (bleeding into the skin), and occur mostly on the palms and soles on the thenar and hypothenar eminences (at the base of the thumb and little finger respectively). They tend to last days to weeks before healing totally. Janeway lesions are more commonly seen in acute end...
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What is the difference between Janeway and Osler nodes?
What does a Osler node look like?
What are Janeway lesions?
What are Osler nodes & Janeway lesions?
Janeway lesions are a sign of liver disease, kidney disease, lung disease, endocarditis and other conditions. They are dark bands on the nail plate that extend from the lunula to the distal tip. They are not present in Osler nodes, which are small, round, white lesions on the nail bed. See images and causes of both lesions.
Janeway's lesions and Osler's nodes are regarded as excellent clues to the diagnosis of infectious endocarditis; however, very few physicians have actually witnessed these findings, and there is some confusion in distinguishing between the two. This article concerns a patient with infectious endocarditis due to Diplococcus pneumoniae, who had tender vesicular lesions thought to be Osler's ...
- Joseph B. Farrior, Mark E. Silverman
- 1976
Fig 1. Janeway lesions on the sole of the foot (A) and palm of the hand (B). Fig 2. Echocardiogram showing endocarditis vegetation. 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.
- Andrea Misin, Stefano Di Bella, Luigi Priolo, Roberto Luzzati
- 10.7861/clinmedicine.17-4-373
- 2017
- Clin Med (Lond). 2017 Aug; 17(4): 373-374.
Jul 24, 2023 · Osler nodes and Janeway lesions are cutaneous manifestations of endocarditis, a disease most commonly arising from a bacterial or fungal infection of the cardiac endocardium. Osler nodes are tender, purple-pink nodules with a pale center and an average diameter of 1 to 1.5 mm. They are generally found on the distal fingers and toes, though they ...
