Differential Diagnosis for Janeway Lesions and Roth Spots
- Single most likely diagnosis:
- Infective Endocarditis: This condition is most commonly associated with both Janeway lesions (non-tender, erythematous or hemorrhagic macules on the palms and soles) and Roth spots (retinal hemorrhages with white or pale centers). The presence of these signs suggests bacterial endocarditis, particularly when accompanied by other symptoms like fever, heart murmur, and embolic phenomena.
- Other Likely diagnoses:
- Systemic Lupus Erythematosus (SLE): While less common, SLE can also present with skin manifestations and retinal findings that might resemble Janeway lesions and Roth spots, respectively. However, the overall clinical context and additional symptoms such as joint pain, renal issues, and specific autoantibodies would help differentiate SLE from infective endocarditis.
- Antiphospholipid Syndrome: This condition can cause retinal vascular occlusions that might appear similar to Roth spots and can also have skin manifestations, though they are less characteristic of Janeway lesions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Meningococcemia: Although less commonly associated with Roth spots, meningococcemia can cause a severe, rapidly progressive infection with skin lesions (purpura) and potentially life-threatening complications if not promptly treated.
- Disseminated Gonococcal Infection: This condition can cause skin lesions and, though less commonly, eye findings. It's a critical diagnosis to consider due to its potential for severe morbidity and the importance of early antibiotic treatment.
- Rare diagnoses:
- Relapsing Fever (caused by Borrelia species): This infection can rarely cause Roth spots and might have skin manifestations, though they are not typically described as Janeway lesions.
- Scurvy: A deficiency in vitamin C can lead to perifollicular petechiae and other skin signs, and though not typically associated with Roth spots, the overall clinical picture could potentially mimic some aspects of the conditions associated with Janeway lesions and Roth spots in very rare and severe cases.