Janeway lesions

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Janeway lesions Classification and external resources

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Evidence Based Medicine
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Clinical Trials
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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.^[1]

Differential Diagnosis

In alphabetical order. ^{[1] [1]}

• 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

Diagnosis

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

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

See also

• Osler's nodes
• Roth's spots

v • d • e Eponymous medical signs for circulatory and respiratory systems, and general chest signs
Cardiovascular system	Blood flow heart murmur (Austin Flint murmur, Still's murmur, Graham Steell murmur) arteries/blood pressure: Allen's test - Osler's sign - Watson's water hammer pulse - aortic insufficiency: Corrigan pulse - De Musset's sign - Duroziez's sign - Müller's sign - Quincke's sign veins (Friedreich's sign, Caput medusae, Kussmaul's sign, Pratt's sign, Lisker's sign, Trendelenburg's test) other: Bainbridge reflex - Beck's triad - Cardarelli's sign - Ewart's sign - Korotkoff sounds - Oliver's sign - Osborn wave - McConnell's sign - Pemberton's sign Heart rheumatic fever: Anitschkow cell - Aschoff body endocarditis: Roth's spot - Janeway lesion - Osler's node - Bracht-Wachter bodies Other Lines of Zahn
Respiratory system	clubbing (Schamroth's window test/Hippocratic fingers) - pulmonary embolism (Hampton hump, Westermark sign) - sarcoidosis (Kveim test) breathing abnormalities (Biot's respiration, Cheyne-Stokes respiration, Kussmaul breathing) - Ferruginous bodies pulmonary edema (Kerley lines)
Chest - general	Adson's sign - Levine's sign - Hamman's sign - Harrison's groove - Kehr's sign

v • d • e WikiDoc Research Resources for Janeway lesions
Articles on Janeway lesions	Most recent articles on Janeway lesions • Most cited articles on Janeway lesions • Review articles on Janeway lesions • Articles on Janeway lesions in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Janeway lesions	Powerpoint slides on Janeway lesions • Images of Janeway lesions • Photos of Janeway lesions • Podcasts & MP3s on Janeway lesions • Videos on Janeway lesions
Evidence Based Medicine Regarding Janeway lesions	Cochrane Collaboration on Janeway lesions • Bandolier on Janeway lesions • TRIP on Janeway lesions
Cost Effectiveness of Janeway lesions	Cost Effectiveness of Janeway lesions
Clinical Trials Involving Janeway lesions	Ongoing Trials on Janeway lesions at Clinical Trials.gov • Trial results on Janeway lesions • Clinical Trials on Janeway lesions at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Janeway lesions	US National Guidelines Clearinghouse on Janeway lesions • NICE Guidance on Janeway lesions • NHS PRODIGY Guidance • FDA on Janeway lesions • CDC on Janeway lesions
Textbook Information on Janeway lesions	Books and Textbook Information on Janeway lesions
Pharmacology Resources on Janeway lesions	Dosing of Janeway lesions • Drug interactions with Janeway lesions • Side effects of Janeway lesions • Allergic reactions to Janeway lesions • Overdose information on Janeway lesions • Carcinogenicity information on Janeway lesions • Janeway lesions in pregnancy • Pharmacokinetics of Janeway lesions •
Genetics, Pharmacogenomics, and Proteinomics of Janeway lesions	Genetics of Janeway lesions • Pharmacogenomics of Janeway lesions • Proteomics of Janeway lesions
Newstories on Janeway lesions	Janeway lesions in the news • Be alerted to news on Janeway lesions • News trends on Janeway lesions
Commentary on Janeway lesions	Blogs on Janeway lesions
Patient Resources on Janeway lesions	Patient resources on Janeway lesions • Discussion groups on Janeway lesions • Patient Handouts on Janeway lesions • Directions to Hospitals Treating Janeway lesions • Risk calculators and risk factors for Janeway lesions
Healthcare Provider Resources on Janeway lesions	Symptoms of Janeway lesions • Causes & Risk Factors for Janeway lesions • Diagnostic studies for Janeway lesions • Treatment of Janeway lesions
Continuing Medical Education (CME) Programs on Janeway lesions	CME Programs on Janeway lesions
International Resources on Janeway lesions	Janeway lesions en Espanol • Janeway lesions en Francais
Business Resources on Janeway lesions	Janeway lesions in the Marketplace • Patents on Janeway lesions
Informatics Resources on Janeway lesions	List of terms related to Janeway lesions

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .