Janeway lesion: Difference between revisions
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{{Infobox medical condition | |||
| name = Janeway lesion | |||
| image = [[File:Janeway_lesion.JPG|left|thumb|Janeway lesion on the palm]] | |||
| caption = Janeway lesion on the palm | |||
| field = [[Cardiology]], [[Infectious disease]] | |||
| symptoms = Painless, erythematous macules on palms and soles | |||
| complications = [[Infective endocarditis]] | |||
| onset = Sudden | |||
| duration = Days to weeks | |||
| causes = [[Bacterial infection]], often associated with [[endocarditis]] | |||
| risks = [[Intravenous drug use]], [[prosthetic heart valves]], [[congenital heart defects]] | |||
| diagnosis = Clinical examination, [[blood culture]] | |||
| differential = [[Osler's nodes]], [[petechiae]], [[splinter hemorrhages]] | |||
| treatment = [[Antibiotics]] for underlying infection | |||
| prognosis = Depends on underlying cause | |||
| frequency = Rare | |||
}} | |||
'''Janeway lesions''' are unique skin manifestations, typically linked with [[infective endocarditis]], a serious infection involving the inner lining of the heart chambers and heart valves<ref>{{cite journal |vauthors=Myers KA, Farquhar DR |title=The rational clinical examination. Does this patient have clubbing? |journal=JAMA |volume=286 |issue=3 |pages=341–7 |year=2001 |pmid=11466101 |doi=10.1001/jama.286.3.341 }}</ref>. These lesions, characterized by their non-tender, small erythematous or haemorrhagic macular, papular or nodular appearance, are predominantly found on the palms or soles. They are often indistinguishable from [[Osler's nodes]], another skin sign of infective endocarditis. The uniqueness of Janeway lesions lies in their asymptomatic nature, presenting without pain or tenderness. | '''Janeway lesions''' are unique skin manifestations, typically linked with [[infective endocarditis]], a serious infection involving the inner lining of the heart chambers and heart valves<ref>{{cite journal |vauthors=Myers KA, Farquhar DR |title=The rational clinical examination. Does this patient have clubbing? |journal=JAMA |volume=286 |issue=3 |pages=341–7 |year=2001 |pmid=11466101 |doi=10.1001/jama.286.3.341 }}</ref>. These lesions, characterized by their non-tender, small erythematous or haemorrhagic macular, papular or nodular appearance, are predominantly found on the palms or soles. They are often indistinguishable from [[Osler's nodes]], another skin sign of infective endocarditis. The uniqueness of Janeway lesions lies in their asymptomatic nature, presenting without pain or tenderness. | ||
==Pathophysiology== | ==Pathophysiology== | ||
The exact pathophysiology of Janeway lesions remains unclear, though the prevailing theory suggests they may be a result of septic microemboli which cause microabscesses in the dermis<ref>{{cite journal |vauthors=White A, Schneider T |title=Clubbing and hypertrophic osteoarthropathy: insights in pathogenesis |journal=Current Opinion in Rheumatology |volume=14 |issue=1 |pages=82–7 |year=2002 |pmid=11753117 |doi=10.1097/00002281-200201000-00015}}</ref>. These microabscesses are essentially small pockets of infection in the skin, causing the characteristic lesions. | The exact pathophysiology of Janeway lesions remains unclear, though the prevailing theory suggests they may be a result of septic microemboli which cause microabscesses in the dermis<ref>{{cite journal |vauthors=White A, Schneider T |title=Clubbing and hypertrophic osteoarthropathy: insights in pathogenesis |journal=Current Opinion in Rheumatology |volume=14 |issue=1 |pages=82–7 |year=2002 |pmid=11753117 |doi=10.1097/00002281-200201000-00015}}</ref>. These microabscesses are essentially small pockets of infection in the skin, causing the characteristic lesions. | ||
==Clinical Presentation== | ==Clinical Presentation== | ||
Clinically, Janeway lesions present as small (only a few millimeters in diameter), non-tender, erythematous or haemorrhagic lesions on the palms or soles. The small size and particular locations of these lesions may make them easily overlooked during a routine physical examination, emphasizing the importance of a thorough skin examination in patients suspected of having infective endocarditis<ref>{{cite journal |vauthors=Murphy C, Lipton S |title=Clubbing of the nails |journal=Postgraduate Medical Journal |volume=73 |issue=865 |pages=663–5 |year=1997 |pmid=9422910 |doi=10.1136/pgmj.73.865.663 |pmc=2431357 }}</ref>. | Clinically, Janeway lesions present as small (only a few millimeters in diameter), non-tender, erythematous or haemorrhagic lesions on the palms or soles. The small size and particular locations of these lesions may make them easily overlooked during a routine physical examination, emphasizing the importance of a thorough skin examination in patients suspected of having infective endocarditis<ref>{{cite journal |vauthors=Murphy C, Lipton S |title=Clubbing of the nails |journal=Postgraduate Medical Journal |volume=73 |issue=865 |pages=663–5 |year=1997 |pmid=9422910 |doi=10.1136/pgmj.73.865.663 |pmc=2431357 }}</ref>. | ||
==Diagnosis and Management== | ==Diagnosis and Management== | ||
Janeway lesions, like other skin manifestations of infective endocarditis, are generally secondary findings in the diagnostic process. They should prompt further investigations, such as blood cultures and echocardiography, for a definitive diagnosis of infective endocarditis. Management of the condition involves addressing the underlying heart infection, often requiring long-term [[antibiotic therapy]], and in severe cases, surgical intervention may be required<ref>{{cite journal |vauthors=Stein PD, Afzal A, Henry JW, Villareal CG |title=Clubbing and hypertrophic osteoarthropathy |journal=Chest |volume=109 |issue=2 |pages=290–5 |year=1996 |pmid=8562797 |doi=10.1378/chest.109.2.290}}</ref>. | Janeway lesions, like other skin manifestations of infective endocarditis, are generally secondary findings in the diagnostic process. They should prompt further investigations, such as blood cultures and echocardiography, for a definitive diagnosis of infective endocarditis. Management of the condition involves addressing the underlying heart infection, often requiring long-term [[antibiotic therapy]], and in severe cases, surgical intervention may be required<ref>{{cite journal |vauthors=Stein PD, Afzal A, Henry JW, Villareal CG |title=Clubbing and hypertrophic osteoarthropathy |journal=Chest |volume=109 |issue=2 |pages=290–5 |year=1996 |pmid=8562797 |doi=10.1378/chest.109.2.290}}</ref>. | ||
==Summary== | |||
== | |||
Janeway lesions provide a critical clue towards the diagnosis of infective endocarditis, underlining the significance of comprehensive skin examinations in the diagnostic process. These lesions, however, are just one component of the broader clinical picture and should be evaluated alongside other signs, symptoms, and diagnostic investigations. | Janeway lesions provide a critical clue towards the diagnosis of infective endocarditis, underlining the significance of comprehensive skin examinations in the diagnostic process. These lesions, however, are just one component of the broader clinical picture and should be evaluated alongside other signs, symptoms, and diagnostic investigations. | ||
==References== | ==References== | ||
{{Reflist}} | {{Reflist}} | ||
Latest revision as of 01:19, 8 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
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| Janeway lesion | |
|---|---|
 | |
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Painless, erythematous macules on palms and soles |
| Complications | Infective endocarditis |
| Onset | Sudden |
| Duration | Days to weeks |
| Types | N/A |
| Causes | Bacterial infection, often associated with endocarditis |
| Risks | Intravenous drug use, prosthetic heart valves, congenital heart defects |
| Diagnosis | Clinical examination, blood culture |
| Differential diagnosis | Osler's nodes, petechiae, splinter hemorrhages |
| Prevention | N/A |
| Treatment | Antibiotics for underlying infection |
| Medication | N/A |
| Prognosis | Depends on underlying cause |
| Frequency | Rare |
| Deaths | N/A |
Janeway lesions are unique skin manifestations, typically linked with infective endocarditis, a serious infection involving the inner lining of the heart chambers and heart valves<ref>,
The rational clinical examination. Does this patient have clubbing?, JAMA, 2001, Vol. 286(Issue: 3), pp. 341–7, DOI: 10.1001/jama.286.3.341, PMID: 11466101,</ref>. These lesions, characterized by their non-tender, small erythematous or haemorrhagic macular, papular or nodular appearance, are predominantly found on the palms or soles. They are often indistinguishable from Osler's nodes, another skin sign of infective endocarditis. The uniqueness of Janeway lesions lies in their asymptomatic nature, presenting without pain or tenderness.
Pathophysiology[edit]
The exact pathophysiology of Janeway lesions remains unclear, though the prevailing theory suggests they may be a result of septic microemboli which cause microabscesses in the dermis<ref>,
Clubbing and hypertrophic osteoarthropathy: insights in pathogenesis, Current Opinion in Rheumatology, 2002, Vol. 14(Issue: 1), pp. 82–7, DOI: 10.1097/00002281-200201000-00015, PMID: 11753117,</ref>. These microabscesses are essentially small pockets of infection in the skin, causing the characteristic lesions.
Clinical Presentation[edit]
Clinically, Janeway lesions present as small (only a few millimeters in diameter), non-tender, erythematous or haemorrhagic lesions on the palms or soles. The small size and particular locations of these lesions may make them easily overlooked during a routine physical examination, emphasizing the importance of a thorough skin examination in patients suspected of having infective endocarditis<ref>,
Clubbing of the nails, Postgraduate Medical Journal, 1997, Vol. 73(Issue: 865), pp. 663–5, DOI: 10.1136/pgmj.73.865.663, PMID: 9422910, PMC: 2431357,</ref>.
Diagnosis and Management[edit]
Janeway lesions, like other skin manifestations of infective endocarditis, are generally secondary findings in the diagnostic process. They should prompt further investigations, such as blood cultures and echocardiography, for a definitive diagnosis of infective endocarditis. Management of the condition involves addressing the underlying heart infection, often requiring long-term antibiotic therapy, and in severe cases, surgical intervention may be required<ref>,
Clubbing and hypertrophic osteoarthropathy, Chest, 1996, Vol. 109(Issue: 2), pp. 290–5, DOI: 10.1378/chest.109.2.290, PMID: 8562797,</ref>.
Summary[edit]
Janeway lesions provide a critical clue towards the diagnosis of infective endocarditis, underlining the significance of comprehensive skin examinations in the diagnostic process. These lesions, however, are just one component of the broader clinical picture and should be evaluated alongside other signs, symptoms, and diagnostic investigations.
References[edit]
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