Janeway lesions are rare, non- tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with

infective endocarditis Infective endocarditis is an infection of the inner surface of the heart (endocardium), usually the heart valve, valves. Signs and symptoms may include fever, petechia, small areas of bleeding into the skin, heart murmur, feeling tired, and anem ...

and often indistinguishable from Osler's nodes.

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.

Differential

Osler's nodes and Janeway lesions are similar and point to the same diagnostic conclusion. The most significant difference between the two is that Osler's nodes present with tenderness, while Janeway lesions do not. Osler's nodes are thought to be due to immunologic phenomenon where deposition of immune complexes provoke inflammatory response, leading to swelling, redness and pain. On the contrary, Janeway lesions are thought to be due to embolic phenomenon in cutaneous blood vessels of palms and soles which does not cause pain or least pain.

Pathophysiology

Pathologically, the lesion is described to be a microabscess of the

dermis The dermis or corium is a layer of skin between the epidermis (skin), epidermis (with which it makes up the cutis (anatomy), cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from s ...

with marked

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

and inflammatory infiltrate not involving the

epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and Subcutaneous tissue, hypodermis. The epidermal layer provides a barrier to infection from environmental pathogens and regulates the ...

. They are caused by septic emboli which deposit bacteria, forming microabscesses.Mandell, Douglas, ''Bennett's Principles and Practice of Infectious Diseases'', 7th ed.,

Churchill Livingstone Churchill Livingstone is an academic publisher. It was formed in 1971 from the merger of Longman's medical list, E & S Livingstone (Edinburgh, Scotland) and J & A Churchill (London, England) and was owned by Pearson. Harcourt acquired Church ...

(2009). Organisms may be cultured from the lesions.

Diagnosis

Janeway lesions present as red, painless macules and papules on the palms and soles. They are not common and are frequently indistinguishable from Osler's nodes. Rarely, they have been reported in cases of

systemic lupus erythematosis Systemic fundamental to a predominant social, economic, or political practice. This refers to: In medicine In medicine, ''systemic'' means affecting the whole body, or at least multiple organ systems. It is in contrast with ''topical'' or ''loc ...

(SLE), gonococcemia (disseminated gonorrhoea),

haemolytic anaemia Hemolytic anemia or haemolytic anaemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). This most commonl ...

and

typhoid fever Typhoid fever, also known simply as typhoid, is a disease caused by '' Salmonella enterica'' serotype Typhi bacteria, also called ''Salmonella'' Typhi. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often th ...

. They may last days to weeks before completely resolving.

History

Janeway lesions are named after Edward Janeway (1841–1911), a prominent American physician, pathologist and contemporary of Sir

William Osler Sir William Osler, 1st Baronet, (; July 12, 1849 – December 29, 1919) was a Canadian physician and one of the "Big Four" founding professors of Johns Hopkins Hospital. Osler created the first Residency (medicine), residency program for speci ...

, who initially described "peculiar skin lesions" in some people with endocarditis, in a paper published in 1899. The term was first used by

internist Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of th ...

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. Osler never mentioned Janeway lesions. The inclusion into Osler's 1925 textbook came six years after Osler died.

References

External links

{{Cardiovascular system symptoms and signs Symptoms and signs: Cardiac Cutaneous conditions