Color of Janeway Lesions in Infective Endocarditis
Janeway lesions are typically red or reddish-purple, non-tender, erythematous macules or nodules that appear on the palms and soles in patients with infective endocarditis 1.
Characteristics of Janeway Lesions
Janeway lesions have several distinguishing features:
- Color: Red to reddish-purple erythematous appearance
- Location: Primarily found on palms and soles
- Sensation: Non-tender (key distinguishing feature from Osler's nodes)
- Morphology: Flat macules or slightly raised nodules
- Pathophysiology: Result from septic emboli causing vascular occlusion and localized vasculitis 2
Differentiating Janeway Lesions from Other Endocarditis Skin Manifestations
It's important to distinguish Janeway lesions from other cutaneous manifestations of infective endocarditis:
| Feature | Janeway Lesions | Osler's Nodes |
|---|---|---|
| Color | Red/reddish-purple | Purple |
| Sensation | Non-tender | Painful/tender |
| Location | Palms and soles | Fingertips and toes |
| Morphology | Flat macules | Nodular lesions |
The key diagnostic difference between Janeway lesions and Osler's nodes is that Janeway lesions are painless, while Osler's nodes are tender 3.
Clinical Significance
The presence of Janeway lesions has important clinical implications:
- They represent a minor criterion in the modified Duke criteria for diagnosing infective endocarditis 1
- Patients with Janeway lesions have a higher risk of extracardiac complications, particularly extracerebral emboli (75% vs 31.8% in patients without these lesions) 2
- Their presence should prompt a thorough search for other embolic phenomena
Diagnostic Value
When Janeway lesions are identified:
- Consider them as part of the vascular phenomena in the minor criteria for IE diagnosis
- Look for other cutaneous manifestations (Osler's nodes, splinter hemorrhages, petechiae)
- Perform comprehensive imaging to identify possible embolic complications, especially extracerebral emboli
- Evaluate for the source of infection with blood cultures and echocardiography
Clinical Pearls
- Janeway lesions are relatively rare in the contemporary era of IE, occurring in only about 1.6% of cases 2
- Their presence may be associated with more severe disease and complications 4
- They can occasionally present unilaterally in cases of localized infection with septic emboli, such as arteriovenous fistula infections 5
- Early recognition can facilitate prompt diagnosis and treatment of infective endocarditis, potentially improving outcomes
When examining a patient with suspected infective endocarditis, careful inspection of the palms and soles for these characteristic red, non-tender macules can provide valuable diagnostic clues and help guide management decisions.