Janeway lesions

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	Janeway lesions;
	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.)

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.
- Stigmata of infectious endocarditis
- Considered a criterion (albeit minor) of vascular phenomena

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)

Janeway Lesions: Flat, painless, erythematous lesions seen on the palm of this patient's hand. Frequently associated with bacterial endocarditis.
Janeway Lesion: Flat, painless, erythematous lesions seen on the palm of this patient's hand. While frequently associated with bacterial endocarditis, in this case, they are the result of an infected radial artery aneurysm (inflamed area proximal to thumb).
Janeway Lesions: Flat, painless, erythematous lesions seen on the palm of this patient's hand. Frequently associated with bacterial endocarditis.
Janeway Lesions: Flat, painless, erythematous lesions seen on the palm of this patient's hand. Frequently associated with bacterial endocarditis.

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

Other Diagnostic Studies

Possible biopsy

Differential Diagnosis

In alphabetical order. ^[3] ^[4]

Acute Pharmacotherapies

IV antibiotics
Antibiotic prophylaxis
Treat all underlying etiologies

Chronic Pharmacotherapies

Antibiotic therapy for bacterial endocarditis

Surgery and Device Based Therapy

Valve replacement for bacterial endocarditis

Indications for Surgery

If all other medical therapy fails (bacterial endocarditis)

References

↑ ^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)
↑ 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.
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)

Janeway lesions

Contents

Overview

Etymology

Diagnosis

History and Symptoms

Laboratory Findings

Chest X Ray

Echocardiography or Ultrasound