Stigmata of IE

Q: In comparison to subacute infective endocarditis (IE), which of the following is more common in acute IE? - select one

A) Janeway lesions

B) Osler nodes 

C) Roth spots

Answer: A

Three major stigmata of Infective Endocarditis (IE) are 

1. Janeway lesions are microabscesses with neutrophil infiltration of capillaries and have the following three characteristics

• Nontender
• appears as erythematous macules 
• usually found on the palms and soles 

2. Osler nodes are the sequelae of vascular occlusion by microthrombi leading to localized immune-mediated vasculitis and have the following three characteristics

• tender
• occurs subcutaneous and appears as violaceous nodules 
• found mostly on the pads of the fingers and toes (may also occur on the thenar and hypothenar eminences)

3. Roth spots are very rare  to find in IE and are also the sequelae of vascular occlusion by microthrombi leading to localized immune-mediated vasculitis, and have the following three characteristics 

• exudative
• edematous hemorrhagic lesions
• found on the retina with pale centers

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References:

1. Gunson TH, Oliver GF. Osler's nodes and Janeway lesions. Australas J Dermatol. 2007 Nov;48(4):251-5. doi: 10.1111/j.1440-0960.2007.00397.x. PMID: 17956487.

2. Loughrey PB, Armstrong D, Lockhart CJ. Classical eye signs in bacterial endocarditis. QJM 2015; 108:909.