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Osler Nodes vs. Janeway Lesions

June 27, 2008

osler nodes vs. janeway lesionsThe differences between these two cutaneous presentations of Infectious endocarditis have always been a bit tricky for me. Finally I decided to solve that problem and here it is:

Osler nodes: Osler’s nodes (painful, palpable, erythematous lesions most often involving the pads of the fingers and toes). Caused by immune complexes (they want you to know that for Step 2). Infectious endocarditis and Roth spots are also due to immune complexes–>immune vasculitis.

Janeway lesions (nontender, macular lesions most commonly involving the palms and soles). Janeway lesions occur more frequently in endocarditis caused by Staphylococcus aureus. Janeway lesions are caused by septic emboli. Subcutaneous abscesses are found on histologic examination.

We can add to the picture and splinter hemorrhages aka fingernail hemorrhage: narrow, red to reddish-brown lines of blood beneath the nails. They run in the direction of nail growth and are named splinter hemorrhages because they look like a splinter beneath the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails or by vessel damage from swelling of the blood vessels (vasculitis). [medlineplus]

The most common cause for splinter hemorrhages is trauma to the nail. [umm]

PICTURE (Credit Children’s Hospital Boston): The lesions in Figures A-C were tender and represent Osler’s nodes, while the lesion in Figure D was nontender and represents a Janeway lesion.

For more pictures showing the differences between Osler Nodes and Janeway Lesions visit er119test.

20 Comments leave one →
  1. June 29, 2008 5:56 am

    Tricky lesions indeed, thanks for reviewing them with us!

    • Anonymous permalink
      October 28, 2013 12:58 pm

      Osler nodes are not caused by immune-complexes but septic emboli as well. I do not know why Janeway lesion are non-tender though.

  2. June 29, 2008 11:27 am

    Hi Alberto,
    I remember before you asked me how to subscribe by e-mail. I figured it out. Just click on the RSS icon and it will show you two options:one is to subscribe by RSS and the other one is by e-mail.

  3. stemcellgeek permalink
    June 30, 2008 8:51 am

    I have your blog in my feeds, I was suggesting a notification on comment reply via email. I’ve been setting up a wordpress blog in these days and I’ve found this plugin essential:
    Maybe you want to give it a try!
    Now let me ask you: how did you put these avatar images? 🙂 Alberto

  4. June 30, 2008 8:52 am

    It’s me!

  5. June 30, 2008 9:11 am

    My picture is a gravatar, something like an universal avatar. You just go to the and make a registration. The rest of the people who don’t have gravatars appear as these funny icons, which is thing. It is automatic option, but if you want you can turn it off.
    The looked at the plugin and definitely it will work but this is for blogs which are hosted by different webhosts. Mine is and I can’t use plugins.

  6. June 30, 2008 9:20 am

    @Alberto:I know that’s you!

  7. June 30, 2008 9:30 am

    Oh, ok, I understand, that is a real pitty that they don’t integrate that feature that I think is really essential to let you follow a comment thread.

    Yeah, my “Alf” is a gravatar too! On the other side I can’t get these gravatars to function in my wordpress blog I have hosted

  8. June 30, 2008 10:13 am

    @Alberto:This one may be can help or try this one

  9. Eric permalink
    April 19, 2011 11:44 am

    For USMLE Step 1 purpose just identify Osler nodes in fingers and toes, while Janeway Lesions in Palms and soles.

  10. June 29, 2011 11:57 am

    This was really helpful. Thanks a lot for the differences!!!

  11. Anonymous permalink
    August 17, 2011 2:11 am

    Thanks for the info it was really helpful….

    • August 18, 2011 6:10 pm

      No problem.

  12. February 12, 2012 4:29 am

    some studies have described both lesions as vasculitis …

  13. September 6, 2012 11:15 am

    How to Remember Dukes Criteria for Infective Endocarditis:

  14. Anonymous permalink
    September 16, 2012 11:41 am

    thanks a lot .really helpful

  15. November 18, 2012 2:20 am


  16. November 18, 2012 2:21 am


  17. Anonymous permalink
    March 30, 2013 1:11 pm

    thank you that was very helpful

  18. Charlotte permalink
    November 3, 2013 4:20 pm

    Really useful, thanks!! 🙂

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