Osler's nodes and Janeway lesions

Gunson, Todd H.; Oliver, G. Fergus

doi:10.1111/j.1440-0960.2007.00397.x

Cited by 39 publications

(27 citation statements)

References 8 publications

(6 reference statements)

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“…39 Emboli and direct invasion of blood vessels present as generalized maculopapular lesions, which evolve rapidly, or as widespread purpuric lesions. Septic embolization can cause Osler's node, Janeway lesions, [40][41][42][43] petechiae, and splinter hemorrhages. 44 We found that the most frequent cutaneous signs were purpuric nonblanching lesions and petechiae.…”

Section: Discussionmentioning

confidence: 99%

Acute bacterial septic vasculopathy

et al. 2012

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Nine of 32 patients were immunosuppressed. The foci of sepsis were variable; in 17 patients, the focus was not identified. Although Neisseria meningitidis was the most common causal agent, several microorganisms were identified. Cutaneous manifestations were an early event in 90.6% of patients. The most common skin signs were purpuric lesions and petechiae. Overall mortality was 28.1%; 65.5% of patients survived without sequelae. Skin biopsies showed thrombi in 100% of cases. Other common findings were inflammatory infiltrate, blood extravasation, and epidermal involvement. Bacteria within the vascular wall were seen in 21.9% of cases and fibrinoid necrosis in 25%. A comparison of ISPs with NISPs disclosed that meningococcemia was more common in the latter group, and the presence of pustules was more common in the former. Histopathology testing revealed that fibrinoid necrosis and bacterial invasion of the vessel wall were more common in ISPs than in NISPs. Conclusions Several microorganisms can cause septic vasculopathy. Clinical presentation is variable and does not depend on the microorganism or the pathogenic mechanism. Histopathologically, septic vasculopathy is a thrombo-occlusive vasculopathy with variable morphology. Cutaneous lesions are an early event and allow for rapid diagnosis.

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Section: Discussionmentioning

confidence: 99%

Acute bacterial septic vasculopathy

et al. 2012

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“…Inflammation, disintegration of inflammatory cells and vessel wall edema finally lead to fibrinoid necrosis of vessel walls and nuclear dust (leukocytoclasia) around destroyed vessels. In the context of disseminated septic diseases, leucocytoclastic vasculitis has been described to cause lesions clinically described as Osler nodules 16 . The clinical hallmark for LV is palpable purpura 17 …”

Section: Differential Diagnosis and Discussionmentioning

confidence: 99%

“…In the context of disseminated septic diseases, leucocytoclastic vasculitis has been described to cause lesions clinically described as Osler nodules. 16 The clinical hallmark for LV is palpable purpura. 17 2.…”

Section: Leukocytoclastic Vasculitis (Lv) LV May Occurmentioning

confidence: 99%

Janeway lesions with inconspicuous histological features

2009

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Septic-embolic diseases are life threatening; survival critically depends on rapid diagnosis. Clinically, cutaneous manifestations like Janeway lesions are infrequently occurring but highly characteristic. In contrast, histological features are not clearly defined. We report the case of a 59-year-old male patient in deteriorating general condition and fever of unknown origin with lesions suggestive for Janeway lesions. Histology showed dilated blood vessels and extravasated erythrocytes throughout the dermis. Only serial sections revealed single, deep dermal vessels occluded by fibrin thrombi. Computed tomography scan identified multiple pulmonary round masses. Blood cultures showed growth of Staphylococcus aureus and Enterococcus faecalis. The knowledge of the described subtle histological features and a clinical-pathological correlation is essential for the diagnosis of certain cases of septic-embolic conditions.

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“…Histologically, Janeway lesions consist of microabscesses in the dermis with thrombosis of small vessels without vasculitis. 1 Osler nodes are distinguished clinically from Janeway lesions (Table 1), 2 and are usually red-purple, tender, slightly raised cutaneous nodules, often with a pale centre. They are usually situated at the tips or sides of fingers or toes, or at the thenar and hypothenar eminences.…”

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confidence: 99%

“…They are usually situated at the tips or sides of fingers or toes, or at the thenar and hypothenar eminences. 2 They are mainly seen in the subacute form of endocarditis and last for hours to several days. In the preantibiotic era, Osler nodes were found in 40% to 90% of patients with endocarditis.…”

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confidence: 99%