The identification of methicillin-resistant Staphylococcus aureus in Osler's nodes and Janeway lesions of acute bacterial endocarditis

Parikh, Sherwin K; Lieberman, Amara; Colbert, David A; Silvers, David N.; Grossman, Marc E.

doi:10.1016/s0190-9622(96)90746-x

Cited by 23 publications

(8 citation statements)

References 4 publications

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“…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.…”

Section: Emboli From Cardiac Vegetationsmentioning

confidence: 99%

Blue (or purple) toe syndrome

Hirschmann¹,

Raugi²

2009

Journal of the American Academy of Dermatology

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Section: Emboli From Cardiac Vegetationsmentioning

confidence: 99%

Blue (or purple) toe syndrome

Hirschmann¹,

Raugi²

2009

Journal of the American Academy of Dermatology

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“…A case has been reported of MRSA endocarditis in which biopsies of both Osler's nodes and Janeway lesions from the same patient within the first 48 hours of appearance showed similar histological findings (neutrophilic dermal abscesses and Gram-positive cocci clustered within vessels). 11 Culture of both the biopsies grew MRSA. This clearly supports the theory postulated by others, 7,9 that Osler's nodes and Janeway lesions may be manifestations of the same pathologic process in different microanatomic sites.…”

Section: Discussionmentioning

confidence: 98%

Osler's nodes and Janeway lesions

Gunson

Oliver

2007

Aust J Dermatology

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The pathogenesis of Osler's nodes and Janeway lesions remains a mystery despite vigorous debate over the last 113 years. They are given great emphasis among the clinical signs of bacterial endocarditis but are seldom seen in practice. Two cases of subacute bacterial endocarditis are presented. A 66-year-old woman with Bartonella henselae endocarditis developed Osler's nodes on the hands postoperatively, and a 23-year-old man with Streptococcus oralis endocarditis developed tender macules with an appearance suggestive of Janeway lesions on one heel. The dermatopathology was similar in the two cases, consisting of a leukocytoclastic vasculitis without micro-abscess formation or visible organisms. Although the appearance is usually consistent, it is not always possible to distinguish Osler's nodes from Janeway lesions based purely on clinical presentation. Furthermore, the histology of both clinical signs can look similar. Further reports are needed before more firm conclusions can be drawn, however, it may be that the histological appearance of Osler's nodes and Janeway lesions is primarily determined by the nature of the causative organism, while the clinical appearance may be determined by anatomical site.

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“…The cause of Osler's nodes has been debated, with more recent authors supporting Osler's original assertion that the lesions result from septic microemboli rather than hypersensitivity or immune complex‐mediated vasculitis. They cite reports of dermal microabscesses and organisms cultured from biopsies of lesions 8,10–12 . Other diverse histologic findings include endothelial swelling and inflammation, perivasculitis, selective focal inflammatory destruction of the neuromyovascular glomus body, and thrombosis with obliteration of superficial arteriolar lumina 11 …”

Section: Osler's Nodesmentioning

confidence: 99%

Getting to the Heart of the Matter

Bernstein

Leasure

Buel

2007

Skinmed

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A 60-year-old woman returned from visiting a cousin in Texas. For the past 6 weeks, she had not been feeling well and had lost almost 30 lb. She had frequent night sweats, although she did not recall having taken her temperature. Upon evaluation in the emergency department, results of physical examination were notable for cachexia and poor dentition. She was noted to have pyuria, and therapy was initiated for a urinary tract infection. Results of blood cultures performed the same day were positive for gram-positive cocci, and vancomycin therapy was initiated. She developed difficulty in seeing to her, left and a computed tomographic scan of the brain was performed; results were interpreted as negative. A transesophageal echocardiogram showed a 3-cm mass attached the posterior leaflet of the mitral valve. Initial interpretation was of an atrial myxoma. One of the authors was asked to consult on the case and noted bilateral conjunctival hemorrhages (Figure 1). Subsequently, the blood culture isolate was identified as Streptococcus mitis. Magnetic resonance imaging confirmed multiple cerebral infarcts consistent with embolic origin. The patient underwent emergent cardiac surgery, and her mitral valve was replaced with a bioprosthetic valve. She successfully completed a 4-week course of antibiotic therapy for her endocarditis.

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The identification of methicillin-resistant Staphylococcus aureus in Osler's nodes and Janeway lesions of acute bacterial endocarditis

Cited by 23 publications

References 4 publications

Blue (or purple) toe syndrome

Blue (or purple) toe syndrome

Osler's nodes and Janeway lesions

Getting to the Heart of the Matter

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