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Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
Janeway lesions are small, painless, erythematous macules found on the palms and soles. These lesions can be seen with both acute and subacute endocarditis. Histological analysis reveals microabscesses with neutrophil infiltration.
Fever in Diseases of the Cardiovascular System
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Microembolic manifestations which were once frequent are not seen regularly in most cases today. Splinter hemorrhages are not confined to patients with valvular infection, and are often seen in others, such as the elderly or in individuals with occupation-related trauma.16,17 Osier nodes are found in some cases, but may be seen in other diseases, including marantic endocarditis, systemic lupus erythematosus, hemolysis, and gonococcal infections. Janeway lesions are more specific and they are more common in staphylococcal endocarditis. Petechiae are not rare, yet less common than previously. However, they may occur in association with a prolonged prothrombin time secondary to heart failure with hepatic congestion or during coumadin administration or salicylate ingestion.1 Conjunctival petechiae, in the absence of infection, are frequently observed in patients who have recently undergone cardiac surgery with heart-lung bypass, and are probably the result of fat microembolism.18 Roth spots occur much less often than previously,2 and they may be found in sepsis of any origin, AIDS, leukemia, severe anemia, and systemic lupus erythematosus.6, 19 They have been reported in a 27-year-old female with fatal rheumatic endocarditis.20
Dermatological manifestations of cardiovascular emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Aseem Sharma, O. Biby Chacko, Madhulika Mhatre
These occur as a result of septic emboli and immunological reactions generated by chronic bacterial infection. They include the following: Splinter hemorrhages: Splinter hemorrhages are subungual, linear, dark-red streaks seen most commonly in the nail bed.Roth spots: Roth spots are oval to ellipsoid hemorrhages with a clear, pale center seen over the retina.Osler nodes: Osler nodes are small, tender nodules that develop on the finger or toe pads and persist for a few hours to days.Janeway lesions: Janeway lesions are polysized hemorrhagic nodules occurring on the palms and soles.Peripheral digital emboli: Peripheral arterial septic emboli from valvular bacterial endocarditis are also seen. These may result in digital infarcts.
Is it really infective endocarditis? Distinguishing systemic vasculitis from its mimics
Published in Scandinavian Journal of Rheumatology, 2022
A Biglia, S Monti, V Morandi, P Delvino, E Bellis, S Rossi, L Cavagna, A Mugellini, C Canino, L Bogliolo, C Montecucco
A 69-year-old woman, with a history of recurrent bronchitis and chronic rhinosinusitis, presented with fever, arthromyalgia, peripheral oedema, and diffuse necrotizing cutaneous lesions, resembling endocarditis-related Janeway lesions, on her hands, the soles of her feet, lips, nostrils, and thigh (Figure 1). The patient had undergone tooth extraction 15 days before the occurrence of symptoms.