Janeway lesions

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Janeway lesions
Skin janeway.jpg
Janeway Lesions: Flat, painless, erythematous lesions seen on the palm of this patient's hand. Frequently associated with bacterial endocarditis.
(Image courtesy of Charlie Goldberg, M.D.)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Janeway lesions are non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are pathognomonic of infective endocarditis.[1] Pathologically, the lesion is described to be a microabscess of the dermis with marked necrosis and inflammatory infiltrate not involving the epidermis, which is due to the deposition of circulating immune complexes in small blood vessels.[1]

Overview

  • Janeway lesions are irregular, flat, painless, erythematous macules found on the palms, soles, thenar and hypothenar eminences of the fingertips, hands and plantar surfaces of the toes.

Etymology

They are named after Edward G. Janeway (1841–1911), a professor of medicine with interests in cardiology and infectious disease.[2]

Diagnosis

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)


History and Symptoms

  • IV drug abuse
  • Infective endocarditis
  • Structural heart disease
  • Heart valve injury/replacement
  • Family history of autoimmune disorders
  • HIV status
  • Mucosal bleeding
  • Head/neck or lung infection
  • Tick exposure
  • Constitutional symptoms

Laboratory Findings

Chest X Ray

Echocardiography or Ultrasound

Other Diagnostic Studies

Differential Diagnosis

In alphabetical order. [3] [4]

Acute Pharmacotherapies

  • IV antibiotics
  • Antibiotic prophylaxis
  • Treat all underlying etiologies

Chronic Pharmacotherapies

Surgery and Device Based Therapy

  • Valve replacement for bacterial endocarditis

Indications for Surgery

References

  1. 1.0 1.1 Farrior, J.B. (1976). "A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis". Chest. 70 (2): 239–43. doi:10.1378/chest.70.2.239. PMID 947688. Unknown parameter |coauthors= ignored (help)
  2. Janeway C. (1998). "Presidential Address to The American Association of Immunologists. The road less traveled by: the role of innate immunity in the adaptive immune response". J. Immunol. 161 (2): 539–44. PMID 9670925.
  3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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