Septic microemboli in a Janeway lesion of bacterial endocarditis

Blue (or purple) toe syndrome

“…Edward Janeway in 1899 and William Osler in 1909 described some of these skin findings, 58 which are now commonly called Janeway lesions and Osler nodes, but with differing and often conflicting definitions. 59,60 Perhaps the most widely adopted distinction characterizes Osler nodes as painful papules on the tips of the fingers and toes and Janeway lesions as painless macules on J AM ACAD DERMATOL VOLUME 60, NUMBER 1 the palms and soles. Skin biopsies or aspirates from several of these lesions have disclosed such features as neutrophilic inflammation (sometimes forming microabscesses), vascular occlusion, septic vasculitis, microemboli, and evidence of the infecting organism on stains and/or culture of the specimens.…”

“…Skin biopsies or aspirates from several of these lesions have disclosed such features as neutrophilic inflammation (sometimes forming microabscesses), vascular occlusion, septic vasculitis, microemboli, and evidence of the infecting organism on stains and/or culture of the specimens. [60][61][62][63][64][65] These findings indicate that at least some of the cutaneous manifestations of endocarditis represent infectious, rather than immunologic, complications and are probably caused by emboli from an infected valve.…”

Skin lesions in the ICU

“…One patient was admitted for acute endocarditis secondary to Streptococcus viridans infection and presented hemorrhagic macular lesions on palms and soles, approximately 2±4 mm in diameter, defined as Janeway's lesions due to septic microemboli in subcutaneous tissue [7].…”

Janeway lesions with inconspicuous histological features

“…Two different types of skin lesions, Janeway lesions and Osler nodules, have been described. Osler nodules are red‐purple, painful nodules often with a pale center and usually located on fingers and toes 6–8 . They have been reported to be associated with subacute/chronic forms of embolic diseases, most commonly bacterial endocarditis 9 .…”

“…Osler nodules are red-purple, painful nodules often with a pale center and usually located on fingers and toes. [6][7][8] They have been reported to be associated with subacute/chronic forms of embolic diseases, most commonly bacterial endocarditis. 9 Janeway lesions, first described by Janeway more than 100 years ago have been associated with acute bacterial endocarditis.…”