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Janeway lesion

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Janeway lesion
Specialty
DurationDays to weeks
CausesInfective endocarditis
Differential diagnosisOsler's nodes

Janeway lesions are non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are often associated with infective endocarditis.[1][2]

They are however rare and frequently indistinguishable from Osler's nodes. Rarely, they maybe associated with Systemic lupus erythematosis (SLE), Gonococcemia (disseminated gonorrhoea), haemolytic anaemia and typhoid fever.[1]

Definition

Janeway lesions are painless, frequently haemorrhagic lesions seen most commonly on the palms and soles, particularly on the base of the thumb and little finger, and seen in infective endocarditis.[1]

Differential

Osler's nodes and Janeway lesions are similar and point to the same diagnostic conclusion. The only noted difference between the two is that Osler's nodes present with tenderness, while Janeway lesions do not.[2]

Pathophysiology

Pathologically, the lesion is described to be a microabscess of the dermis with marked necrosis and inflammatory infiltrate not involving the epidermis.[2]

They are caused by septic emboli which deposit bacteria, forming microabscesses.[3] Organisms may be cultured from the lesions.[4]

Janeway lesions are distal, flat, ecchymotic, and painless.[citation needed]

Diagnosis

Janeway lesions present as painless, non tender, subcutaneous maculopapular lesions on the pulp of the finger most commonly due to allergic or toxic inflammation of the vessel wall.[citation needed]

Not commonly seen, they are also often indistinguishable from Osler's nodes.[2]

They may last days to weeks before completely resolving.[1]

History

Janeway lesions are named after Edward Janeway (1841–1911), a prominent American physician, pathologist and contemporary of Sir William Osler, who initially described "peculiar skin lesions" in some people with endocarditis, in a paper published in 1899. The term was first used by internist and pathologist Emanuel Libman, who reported the lesions in his paper of 1906 and explained his reasoning for using the term "Janeway lesions" in a footnote in 1923.[5]

See also

References

  1. ^ a b c d "Osler nodes and Janeway lesions | DermNet NZ". www.dermnetnz.org. Retrieved 2 October 2019.{{cite web}}: CS1 maint: url-status (link)
  2. ^ a b c d Farrior, J.B.; Silverman M.E. (1976). "A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis". Chest. 70 (2): 239–243. doi:10.1378/chest.70.2.239. PMID 947688.
  3. ^ Mandell, Douglas, Bennett's Principles and Practice of Infectious Diseases, 7th ed., Churchill Livingstone (2009).
  4. ^ Patterson, James W. (2016). "8. The Vasculopathic Reaction Pattern". Weedon's Skin Pathology (4th ed.). Churchill Livingston. pp. 239–240. ISBN 9780702051838.
  5. ^ "Edward G. Janeway, Clinician and Pathologist" (PDF). Clinical Cardiology. 29 (8): 376–377. 2006. doi:10.1002/clc.4960290815. PMC 6654287. {{cite journal}}: Unknown parameter |authors= ignored (help)

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