Janeway lesions
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.) |
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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.
- 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)
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
- Blood cultures
- Complete blood count (CBC) with peripheral smear
- Antinuclear antibody (ANA)
- Rapid plasma reagin (RPR)
- Erythrocyte sedimentation rate (ESR)
- Antistreptolysin O antibodies (ASO)
- Urinalysis
- Coagulation studies
- Anti-SM antibodies
- Anti-dsDNA antbodies
Chest X Ray
Echocardiography or Ultrasound
Other Diagnostic Studies
- Possible biopsy
Differential Diagnosis
In alphabetical order. [3] [4]
- Acute bacterial endocarditis
- Coxsackievirus
- Cutaneous vasculitis
- Disseminated Intravascular Coagulation (DIC)
- Echovirus
- Erythema multiforme
- Idiopathic thrombocytopenia purpura
- Meningococcemia
- Polyarteritis Nodosa
- Rocky Mountain Spotted Fever
- Secondary syphilis
- Subacute bacterial endocarditis
- Systemic Lupus Erythematosus
- Thrombotic thrombocytopenic purpura
- Typhoid Fever
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
See also
Template:Eponymous medical signs for circulatory and respiratory systems