Janeway lesions

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. 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.

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.

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

 * Chest X-ray

Echocardiography or Ultrasound

 * Echocardiogram

Other Diagnostic Studies

 * Possible biopsy

Differential Diagnosis
In alphabetical order.


 * 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)