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1

Flores Umanzor, Eduardo Josué, Guillem Caldentey Adrover, Rodolfo San Antonio, and Luca Vannini. "Lesiones de Janeway, nódulos de Osler y hemorragias en astilla." Medicina Clínica 147, no. 2 (2016): e11. http://dx.doi.org/10.1016/j.medcli.2015.11.041.

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2

González-Cortiñas, Modesto, Alberto Román-Abreu, and Lumey Hernández-Niebla. "Aneurisma micótico, una rara complicación de la endocarditis infecciosa." Revista de la Sociedad Peruana de Medicina Interna 37, no. 3 (2024): 147–51. http://dx.doi.org/10.36393/spmi.v37i3.859.

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Mujer de 57 años de edad, con dolor lumbar izquierdo irradiado al abdomen de tres semanas de evolución. Una semana después presentó fiebre recurrente y vespertina, con lesiones dérmicas en los miembros, cuya biopsia diagnosticó vasculitis leucocitoclástica. Dos semanas después, la paciente ingresó por fiebre y mialgias. En el examen se halló lesiones de Janeway en las palmas, un soplo sistólico irradiado a la axila y manchas de Roth en el fondo de ojo. Los hemocultivos fueron positivos para Staphylococcus aureus y el ecocardiograma mostró vegetaciones en la válvula mitral. Hubo buena respuesta clínica al tratamiento antibiótico. En los días siguientes al alta, la paciente presentó dolor en la nalga izquierda. Un mes después del alta, la paciente reingresó con dolor intenso y aumento de volumen en la región glútea izquierda. Fue intervenida de emergencia y se halló un hematoma y sangrado por la ruptura de un aneurisma de la arteria femoral circunfleja medial izquierda. Después del alta, la paciente es seguida y se halla en buenas condiciones. Se pone el énfasis en que la ruptura de un aneurisma micótico es una rara complicación de la endocarditis bacteriana.
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3

Beaulieu, A., and H. U. Rehman. "Janeway lesions." Canadian Medical Association Journal 182, no. 10 (2010): 1075. http://dx.doi.org/10.1503/cmaj.091528.

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4

Chhabria, B. A., R. V. Nampoothiri, A. A. Gawalkar, and S. Jain. "Janeway lesions." QJM: An International Journal of Medicine 110, no. 7 (2017): 471–72. http://dx.doi.org/10.1093/qjmed/hcx067.

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5

Khanna, Naveen, Ambuj Roy, and Vinay K. Bahl. "Janeway Lesions." Circulation 127, no. 7 (2013): 861. http://dx.doi.org/10.1161/circulationaha.112.127787.

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6

Reddy, IndukooruS, and Swarnalata Gowrishankar. "Janeway lesions - Revisited." Indian Journal of Dermatology, Venereology, and Leprology 79, no. 1 (2013): 136. http://dx.doi.org/10.4103/0378-6323.104693.

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7

Hernández-Fonseca, Arturo Yimaraes, Carlos Adrián Pérez-Martínez, and Fernando Padilla-Santamaría. "Endocarditis infecciosa asociada a enfermedad renal crónica: reporte de caso y revisión de la literatura." Revista Cadena de Cerebros 5, no. 2 (2021): 100–106. https://doi.org/10.5281/zenodo.5111343.

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<strong>RESUMEN</strong> La endocarditis infecciosa es una enfermedad que afecta a m&uacute;ltiples sistemas y resulta de una infecci&oacute;n, generalmente bacteriana, de la superficie endoc&aacute;rdica del coraz&oacute;n, siendo una causa importante de morbilidad y mortalidad en pacientes que reciben hemodi&aacute;lisis por enfermedad renal cr&oacute;nica (ERC) establecida. En el presente art&iacute;culo se expone una revisi&oacute;n bibliogr&aacute;fica a prop&oacute;sito del caso de un paciente masculino de 28 a&ntilde;os de edad con endocarditis asociada a ERC en tratamiento sustitutivo renal modalidad hemodi&aacute;lisis y bacteriemia por angiacceso, ya que el riesgo es significativamente m&aacute;s com&uacute;n que en la poblaci&oacute;n general debido al uso de v&iacute;as intravasculares, siendo una infecci&oacute;n en aumento en estos pacientes, generando ingresos prolongados y un mal pron&oacute;stico con hasta 37% de mortalidad durante la hospitalizaci&oacute;n y 50% al a&ntilde;o. Debido a las estad&iacute;sticas en nuestro pa&iacute;s acerca de la mortalidad en la ERC que posiciona a las enfermedades cardiovasculares en primer lugar y en segundo a las infecciosas, es de suma importancia reconocer a la endocarditis infecciosa como un factor que contribuye a la mortalidad, ya que en muchas ocasiones existe un subdiagn&oacute;stico debido a la gran variedad de presentaciones cl&iacute;nicas no reconocidas y a que la mayor&iacute;a de estos pacientes se diagnostican cuando se presentan cuadros severos y posterior a la exclusi&oacute;n de otras entidades, con un incremento en la mortalidad de los pacientes. En todos los pacientes con ERC en hemodi&aacute;lisis con respuesta inflamatoria se debe realizar escrutinio y aplicar los criterios diagn&oacute;sticos ya establecidos para endocarditis. &nbsp; &nbsp; <strong>ABSTRACT</strong> Infective endocarditis is a disease that affects multiple systems and results from an infection, usually bacterial, of the endocardial surface of the heart, being an important cause of morbidity and mortality in patients receiving hemodialysis for established chronic kidney disease (CKD). This article presents a bibliographic review on the case of a 28-year-old male patient with infective endocarditis secondary to CKD undergoing renal replacement therapy (hemodialysis modality), since the risk is significantly more common than in the general population due to the use of intravascular routes, with an increasing infection in these patients, generating prolonged admissions and a poor prognosis with up to 37% mortality during hospitalization and 50% per year. Due to the statistics in our country about mortality in CKD that place cardiovascular diseases in first place and infectious diseases second, it is extremely important to recognize infective endocarditis as a factor that contributes to mortality, since in many times, there is an underdiagnosis due to the great variety of unrecognized clinical presentations, since most of these patients are diagnosed when they present severe conditions and after the exclusion of other entities, with an increase in the mortality of the patients. In all CKD patients on hemodialysis who present evidence of infection, fever with no apparent source, or embolic phenomena, infective endocarditis should be considered as an initial diagnostic suspicion.
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8

Ribeiro Sarques, Patricia, Lívia Crisóstomo Deldoti, Francisca Mabel Meza Nuñez, and Alex Pesci Duarte. "Endocarditis infecciosa por Staphylococcus aureus." Epicentro - Revista de Investigación Ciencias de la Salud 1, no. 2 (2022): 73–75. http://dx.doi.org/10.59085/2789-7818.2021.23.

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Relato de caso de una paciente con endocarditis de etiología bacteriana por el agente Staphylococcus Aureus en válvula aortica calcificada. Se describe el cuadro clínico de la paciente, los exámenes realizados con los respectivos resultados, métodos terapéuticos y el desfecho del caso. Además, se discuten los hallazgos semiológicos encontrados en el examen físico. Introducción El presente trabajo desarrolla los puntos fundamentales sobre la infección del endocardio producidas por bacterias, enfocando en la amplia agresividad de los Staphylococcus aureus, “La bacteriemia por Staphylococcus aureus meticilina resistente es un problema especialmente importante por la elevada mortalidad que condiciona.” (GUDIOL, F, 2009) Es una enfermedad infecciosa que afecta el endocardio y las válvulas cardíacas (1) capaz de provocar un alto riesgo para la vida, por lo cual el pronóstico depende de muchos factores como la virulencia y el estado del paciente. Las manifestaciones clínicas son la fiebre, el soplo cardíaco que ocurre en 90% de las endocarditis infecciosas izquierdas, astenia, pérdida de peso y alteraciones cutáneos que se describen a continuación (1)(2). La Endocarditis es de difícil diagnóstico, el tratamiento adecuado resulta ser indispensable para prevenir posibles complicaciones. Los Staphylococcus aureus son cocos grampositivos, catalasa-positivos dispuestos en racimos. Los factores de virulencia incluyen componentes estructurales que facilitan la adherencia a los tejidos del hospedador o evitan la fagocitosis, y una variedad de toxinas o de enzimas hidrolíticas. (3) Los factores de riesgo a una infección por Staphylococcus aureus comprenden la presencia de un cuerpo extraño, un procedimiento quirúrgico previo y el empleo de antibióticos que suprimen la flora microbiana normal. (3) Cerca de 90% de los Staphylococcus aureus presentan resistencia a la penicilina G y casi la mitad es resistente a meticilina. (4) Informe de caso Paciente femenina de 32 años acude al consultorio por fiebre de 39º C e inapetencia de tres días de evolución. A la exploración física se encontraba en estado general regular, eupneica, lívida, temperatura de 39º C, Fc 93 Lpm, PA 120/60 mm/Hg. En el examen físico cardiaco la auscultación mostró ritmo cardíaco regular, soplo sistólico 3 + / 6 +(Levine,1933) (5) en el área aórtica, irradiado al borde esternal izquierdo y foco mitral, con soplo diastólico 3 + / 6 + en el área aórtica. En la evaluación de la mucosa oral se constató mal estado de higiene y salud. Presentaba nódulo de Osler (nódulo eritematoso doloroso) en punta de los dedos, lesiones de Janeway (pápulas eritematosas no dolorosas) en planta de las manos y petequias rojo-violáceas en cara y esclera. Paciente reveló antecedentes de fiebre reumática a los 5 años. En el laboratorio: Hemoglobina 10,4g/dl Hematocrito 30,7% Leucocitos 7800 El ecocardiograma mostró válvula aórtica trivalvar calcificada con doble disfunción e imagen a nivel del anillo valvular que se proyectaba hacia el seno coronario con un aspecto rugoso compatible con vegetación crónica. A los 2 días de ingreso se inició tratamiento con penicilina cristalina y gentamicina, hubo una mejoría del estado general, pero con persistencia de la fiebre. Cinco días después se identificó el crecimiento de Staphylococcus aureus en los pares de hemocultivos recogidos. Se cambió el tratamiento a oxacilina + gentamicina (4) con resultado exitoso. Conclusión Según los criterios de Duke (Criterios diagnósticos para la endocarditis infecciosa) (2) la paciente presentaba al inicio: Un criterio mayor, evidencia de afectación endocárdica en ecocardiograma y cuatro criterios menores: fiebre de 39°C, nódulos Osler, lesiones de Janeway y evidencias serológicas de infección, resultante de los hemocultivos. Se inició tratamiento empírico padrón para endocarditis con penicilina cristalina asociada a gentamicina. Tras la información del agente causal anteriormente citado, conocidos por tener cepas resistentes a la meticilina (4), el tratamiento fue modificado para mejor atender la necesidad de la paciente y garantizar la total supresión del microbio con oxacilina asociada a gentamicina que presentan mejor respuesta antimicrobiana específica a este agente. El tratamiento logró buenos resultados devolviendo a la paciente su estado de bienestar físico y el regreso a su vida cotidiana. Es necesario evitar factores de riesgo como mala higiene bucal, monitorear pacientes que tuvieran fiebre reumática y uso adecuado de antibioticoterapia para evitar cepas resistentes.
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9

Gunson, Todd H., and G. Fergus Oliver. "Osler's nodes and Janeway lesions." Australasian Journal of Dermatology 48, no. 4 (2007): 251–55. http://dx.doi.org/10.1111/j.1440-0960.2007.00397.x.

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10

Divakaramenon, S. M. "Janeway lesions in infective endocarditis." Heart 91, no. 4 (2005): 516. http://dx.doi.org/10.1136/hrt.2004.045179.

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11

Hernández-Ramírez, José M., Stefano Urso, and Rafael Granados. "Localized Janeway lesions after ECMO." Intensive Care Medicine 43, no. 3 (2016): 449. http://dx.doi.org/10.1007/s00134-016-4609-8.

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12

Marrie, Thomas J. "Osler’s Nodes and Janeway Lesions." American Journal of Medicine 121, no. 2 (2008): 105–6. http://dx.doi.org/10.1016/j.amjmed.2007.07.035.

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13

Alameddine, Abdallah K., Brian Binnall, and Ziad O. Alameddine. "Resolution of extensive Janeway lesions." Journal of Cardiac Surgery 32, no. 5 (2017): 295. http://dx.doi.org/10.1111/jocs.13134.

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14

Anam, Ahmad Mursel, Farzana Shumy, Adnan Shareef, and Raihan Rabbani. "Janeway Lesions in Systemic Lupus Erythematosus." Journal of Bangladesh College of Physicians and Surgeons 34, no. 1 (2016): 48–49. http://dx.doi.org/10.3329/jbcps.v34i1.29168.

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15

Loewe, Robert, Klaus B. Gattringer, and Peter Petzelbauer. "Janeway lesions with inconspicuous histological features." Journal of Cutaneous Pathology 36, no. 10 (2009): 1095–98. http://dx.doi.org/10.1111/j.1600-0560.2008.01231.x.

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16

Kittisupamongkol, Weekitt. "Janeway Lesions, Osler Nodes, or Neither?" Archives of Neurology 67, no. 3 (2010): 373. http://dx.doi.org/10.1001/archneurol.2010.8.

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17

Trigo, Ana. "Nódulos de Osler e Lesões de Janeway: Da Clínica ao Diagnóstico." Medicina Interna 28, no. 3 (2021): 275–76. http://dx.doi.org/10.24950/cc/93/21/3/2021.

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18

Oiwa, Hiroshi, and Kenji Nishioka. "Janeway Lesions in Eosinophilic Granulomatosis with Polyangiitis." Internal Medicine 55, no. 5 (2016): 549–50. http://dx.doi.org/10.2169/internalmedicine.55.5819.

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19

Hirai, T., and M. Koster. "Osler's nodes, Janeway lesions and splinter haemorrhages." Case Reports 2013, sep06 1 (2013): bcr2013009759. http://dx.doi.org/10.1136/bcr-2013-009759.

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20

Flores Umanzor, Eduardo Josué, Guillem Caldentey Adrover, Rodolfo San Antonio, and Luca Vannini. "Janeway lesions, Osler nodes and splinter hemorrhages." Medicina Clínica (English Edition) 147, no. 2 (2016): e11. http://dx.doi.org/10.1016/j.medcle.2016.09.008.

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21

PINO GIL, M., M. VELASCO, R. BOTELLA, J. E. BALLESTER, F. PEDRO, and A. ALIAGA. "JANEWAY LESIONS: DIEEERENTIAL DIAGNOSIS WITH OSLER'S NODES." International Journal of Dermatology 32, no. 9 (1993): 673–74. http://dx.doi.org/10.1111/j.1365-4362.1993.tb04025.x.

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Yamamoto, M., R. Inokuchi, K. Nakamura, and N. Yahagi. "Psoriatic erythroderma-induced septicaemia causing Janeway lesions." Case Reports 2014, dec11 1 (2014): bcr2014207587. http://dx.doi.org/10.1136/bcr-2014-207587.

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Navi, Babak B. "Janeway Lesions, Osler Nodes, or Neither?—Reply." Archives of Neurology 67, no. 3 (2010): 373. http://dx.doi.org/10.1001/archneurol.2010.9.

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Misin, Andrea, Stefano Di Bella, Luigi Priolo, and Roberto Luzzati. "Image of the month: ‘Diagnostic hands’: Janeway lesions." Clinical Medicine 17, no. 4 (2017): 373–74. http://dx.doi.org/10.7861/clinmedicine.17-4-373.

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Panginikkod, Sreelakshmi, Venu Gopalakrishnan, Malav Parikh, and Niyati Gupta. "Janeway Lesions: a Painless Manifestation of Infective Endocarditis." Journal of General Internal Medicine 34, no. 7 (2019): 1360–61. http://dx.doi.org/10.1007/s11606-018-4770-6.

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26

Cardullo, Alice C., David N. Silvers, and Marc E. Grossman. "Janeway lesions and Osier's nodes: A review of histopathologic findings." Journal of the American Academy of Dermatology 22, no. 6 (1990): 1088–90. http://dx.doi.org/10.1016/0190-9622(90)70157-d.

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Fareedy, Shoaib Bilal, Priya Rajagopalan, and Espana Christian Schmidt. "Janeway lesions: a valuable clinical sign in patients with infective endocarditis." Journal of Community Hospital Internal Medicine Perspectives 6, no. 2 (2016): 30660. http://dx.doi.org/10.3402/jchimp.v6.30660.

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VanderWielen, Beth, and Somnath Bose. "Janeway lesions and Osler’s nodes: an indication for prompt transesophageal echocardiography." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 64, no. 5 (2017): 542–43. http://dx.doi.org/10.1007/s12630-017-0832-1.

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Usui, Shunya, Teruki Dainichi, Akihiko Kitoh, Yoshiki Miyachi, and Kenji Kabashima. "Janeway Lesions and Splinter Hemorrhages in a Patient With Eosinophilic Endomyocarditis." JAMA Dermatology 151, no. 8 (2015): 907. http://dx.doi.org/10.1001/jamadermatol.2015.0388.

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Alpert, Joseph S. "Osler's Nodes and Janeway Lesions Are Not the Result of Small-Vessel Vasculitis." American Journal of Medicine 126, no. 10 (2013): 843–44. http://dx.doi.org/10.1016/j.amjmed.2013.04.002.

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Mathes, Alexander, Mansur Duran, Angelo Tortora, and Kerim Beseoglu. "Janeway lesions as the primary sign of an infected radial artery aneurysm after cannulation." Intensive Care Medicine 42, no. 7 (2015): 1172–73. http://dx.doi.org/10.1007/s00134-015-4091-8.

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32

Cheng, Chien-Sheng, Ming-Jenn Lee, and Fang Qing Liu. "Mees Line of Nails, Osler Nodes, Janeway Lesions as evidence of disseminated intravascular coagulation." Journal of Microbiology, Immunology and Infection 48, no. 2 (2015): S69. http://dx.doi.org/10.1016/j.jmii.2015.02.240.

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33

Sethi, Karishma, Jim Buckley, and Jacob de Wolff. "Splinter haemorrhages, Osler's nodes, Janeway lesions and Roth spots: the peripheral stigmata of endocarditis." British Journal of Hospital Medicine 74, Sup9 (2013): C139—C142. http://dx.doi.org/10.12968/hmed.2013.74.sup9.c139.

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34

Como, N., D. Kraja, E. Zogu, et al. "Epidemiological, topographic and prognostic aspects of Janeway lesions and Osler nodules in Infectious Endocarditis." International Journal of Infectious Diseases 73 (August 2018): 153. http://dx.doi.org/10.1016/j.ijid.2018.04.3761.

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35

Tripathi, Sushil P., Devendra Borgaonkar, and Prafulla G. Kerkar. "Preantibiotic era revisited: Janeway's lesions and Osler's nodes." European Heart Journal 37, no. 25 (2015): 2002. http://dx.doi.org/10.1093/eurheartj/ehv661.

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36

Andrew Kim, Cristian Valdez, Tony Alarcon, et al. "A late-onset leg rash, unique Janeway lesions or Jarisch-Herxheimer reaction? A case report." World Journal of Advanced Research and Reviews 20, no. 1 (2023): 400–403. http://dx.doi.org/10.30574/wjarr.2023.20.1.2067.

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Jarisch-Herxheimer reactions typically manifest as a response to antimicrobial therapy for spirochete infections, although these reactions have also been documented following treatment of other microbes. Almost always occurring within 24 hours of treatment initiation, Jarisch-Herxheimer reactions can cause hypotension, fevers, chills, headaches, myalgia, skin rashes, and exacerbations of existing skin lesions, among others; the most feared complication from such reactions is shock. They are usually transient and self-limiting but can cause significant discomfort and concern for patients. Treatment is usually supportive, consisting mostly of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and intravenous fluids. Reactions with delayed onset are exceedingly rare, and to our knowledge, have been documented only one other time in literature. In this clinical vignette, we present a case in which a patient developed what we initially suspected to be Janeway lesions; however, the presence of systemic symptoms suggest that what was observed was delayed-onset Jarisch-Herxheimer reaction 16 days after initiation of antibiotics.
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Andrew, Kim, Valdez Cristian, Alarcon Tony, et al. "A late-onset leg rash, unique Janeway lesions or Jarisch-Herxheimer reaction? A case report." World Journal of Advanced Research and Reviews 20, no. 1 (2023): 400–403. https://doi.org/10.5281/zenodo.12185873.

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Jarisch-Herxheimer reactions typically manifest as a response to antimicrobial therapy for spirochete infections, although these reactions have also been documented following treatment of other microbes. Almost always occurring within 24 hours of treatment initiation, Jarisch-Herxheimer reactions can cause hypotension, fevers, chills, headaches, myalgia, skin rashes, and exacerbations of existing skin lesions, among others; the most feared complication from such reactions is shock. They are usually transient and self-limiting but can cause significant discomfort and concern for patients. Treatment is usually supportive, consisting mostly of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and intravenous fluids. Reactions with delayed onset are exceedingly rare, and to our knowledge, have been documented only one other time in literature. In this clinical vignette, we present a case in which a patient developed what we initially suspected to be Janeway lesions; however, the presence of systemic symptoms suggest that what was observed was delayed-onset Jarisch-Herxheimer reaction 16 days after initiation of antibiotics.
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38

Mohanan, Sandeep, Jabir Sayed, Rakesh Jain, and P. Jayeshkumar. ""Janeway Lesions, Osler′s Node, and Splinter Hemorrhages in a Case of Acute Infective Endocarditis"." Heart India 3, no. 4 (2015): 106. http://dx.doi.org/10.4103/2321-449x.168472.

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39

Ochiai, Tomoki, Yutaka Tanaka, Keiko Aso, et al. "Rapid diagnosis of prosthetic valve endocarditis from Janeway lesions in a transcatheter aortic valve implantation patient." Journal of Cardiology Cases 13, no. 2 (2016): 63–66. http://dx.doi.org/10.1016/j.jccase.2015.10.007.

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40

Parikh, Sherwin K., Amara Lieberman, David A. Colbert, David N. Silvers, and Marc E. Grossman. "The identification of methicillin-resistant Staphylococcus aureus in Osler's nodes and Janeway lesions of acute bacterial endocarditis." Journal of the American Academy of Dermatology 35, no. 5 (1996): 767–68. http://dx.doi.org/10.1016/s0190-9622(96)90746-x.

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41

Shen, Ying-Chi, Kai-Chun Chang, and Jen-Jen Su. "Cutaneous manifestations of infective endocarditis as presenting signs of left atrial myxoma in a patient with acute ischemic stroke: A case report." Medicine 103, no. 36 (2024): e39088. http://dx.doi.org/10.1097/md.0000000000039088.

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Rationale: Approximately one-fifth ischemic stroke are attributed to cardioembolism. Patients with cardioembolic stroke often develop a more severe disability and a higher risk of stroke recurrence. Cardiac myxoma, although uncommon, can serve as a potentially curable cause of acute embolic strokes. Patient concerns: A 55-year-old male patient presented to the emergency department with acute vertigo and unsteady gait, accompanied by left upper limb numbness. Concurrently, purple-like lesions on the left hand were noticed. Diagnoses: Brain magnetic resonance imaging showed multiple infarctions in the posterior circulation. Additionally, skin examination showed Janeway lesions, Osler nodes and splinter hemorrhages. There was no evidence of systemic infection. Subsequently, transthoracic echocardiogram revealed a left atrial myxoma. Intervention: Early surgical resection of cardiac myxoma was performed. Outcomes: The patient recovered well from the surgery. No recurrent embolic event was reported at 3-month postoperatively. Lessons: Clinicians should be vigilant for skin manifestations of cardiac embolism. In patients with acute ischemic strokes, the presence of cutaneous embolic phenomena could serve as a warning sign of cardioembolism.
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42

Rali, Aniket S., Arun Iyer, Claire Sullivan, James Strainic, and Brian Hoit. "Septic pulmonary emboli from mitral valve endocarditis in a patient with repaired tetralogy of fallot." Case Reports in Internal Medicine 3, no. 3 (2016): 7. http://dx.doi.org/10.5430/crim.v3n3p7.

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A 37-year-old woman with a past medical history significant for congenital deafness and surgically repaired Tetralogy ofFallot presented with three day history of nausea, vomiting, fever, chills, dyspnea, and lower extremity weakness and physicalexamination notable for Janeway lesions. Peripheral blood and urine cultures were positive for methicillin sensitive Staphlococcusaureus. Transesophageal echocardiogram was consistent with mitral valve endocarditis. Computed tomography images of thechest, abdomen and pelvis demonstrated septic emboli to multiple organs including lungs, liver, spleen and kidneys. Salinecontrast study was negative for a patent foramen ovale, or residual ventricular septal defect. Thus, effectively ruling out left toright intracardiac shunt as the cause of pulmonary septic emboli from mitral valve endocarditis. Moreover, cardiac MRI did notshow any evidence of right sided endocarditis. Therefore, we believe the source of septic pulmonary emboli from mitral valveendocarditis to be through the bronchial arteries. The extent of septic emboli to various organs and the precise mechanism ofpulmonary emboli from left sided endocarditis in a patient with surgically altered cardiac anatomy make this case unique.
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43

Sastroasmoro, Sudigdo, Bambang Madiyono, Ismet N. Oesman, and Sukman Tulus Putra. "Bacterial endocarditis in children: clinical and laboratory findings, and the role of echocardiography in its diagnosis and management." Paediatrica Indonesiana 29, no. 9-10 (1989): 188–98. http://dx.doi.org/10.14238/pi29.9-10.1989.188-98.

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We report clinical and laboralory findings of 15 children with bacterial endocarditis, admitted ro the Department of Child Health, University of Indonesia/Cipto Mangunkusumo Hospital from February, 198710 June, 1989.There were 8 boys and 7 girls with bacterial endocarditis, ranging in age from 10 weeks 10 16 years. The diagnosis was suspected because of prolonged fever, with or without other manifestations, i.e. congestive heart failure, refractory anemia, or paroxysmal atrial tachycardia. The underlying heart disease was congenital in 12 cases and rheumatic heart disease in 3 cases.The clinical, electrocardiographic, and radiologic manifestations were generally predominated by the pre-existing heart disease. No characteristic findings of bacterial endocarditis, i.e. Osler's nodes, Janeway lesions or splinter haemorrhages were detected.Positive bacterial culture was obtained in 12 cases; the most frequent bacteria isolated was Pseudomonas aeruginosa (4 cases), Streptococcus viridans was isolated in 2 cases only.Vegetation was visualized echocardiographically in 12 cases; 9 with clear cut evidence of large vegetation, and the other 3 the vegetation was equivocal. On follow-up they disappeared gradually with clinical improvemenl. Large vegetation might need 2 full months 10 disappear echocardiographically.
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Moreiras Arias, N., G. Pita da Veiga, J. M. Suárez Peñaranda, and M. Pousa Martínez. "Lesiones tipo manchas de Janeway asociadas a sepsis de origen respiratorio." Actas Dermo-Sifiliográficas, December 2022. http://dx.doi.org/10.1016/j.ad.2022.02.035.

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45

Moreiras Arias, N., G. Pita da Veiga, JM Suárez Peñaranda, and M. Pousa Martínez. "Lesiones tipo manchas de Janeway asociadas a sepsis de origen respiratorio." Actas Dermo-Sifiliográficas, May 2023. http://dx.doi.org/10.1016/j.ad.2023.05.006.

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46

Jiménez Melo, Octavio Raul, María Jesús Pinilla Lozano, Elena Morte Romea, and Alejandro Andrés Gracia. "‘Diagnostic hands’: Janeway lesions—a forgotten entity." European Heart Journal - Case Reports 5, no. 1 (2021). http://dx.doi.org/10.1093/ehjcr/ytaa490.

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47

Martinez, Jake C., Abdulbaril Olaganju, and Roderick Tung. "Janeway Lesions as a Manifestation of Aortic Graft Abscess." Annals of Internal Medicine: Clinical Cases 2, no. 2 (2023). http://dx.doi.org/10.7326/aimcc.2022.1012.

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48

Castrichini, Matteo, Robert J. Haemmerle, and Pritish K. Tosh. "Cutaneous Stigmata of Bacterial Endocarditis." JAMA Dermatology, April 3, 2024. http://dx.doi.org/10.1001/jamadermatol.2024.0481.

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49

Ruwanpathirana, Pramith, Harindri Athukorala, Praveen Weeratunga, and Panduka Karunanayake. "Unilateral Osler nodes, Janeway lesions and splinter haemorrhages associated with surgical arterio-venous fistula infection: a case report." BMC Infectious Diseases 23, no. 1 (2023). http://dx.doi.org/10.1186/s12879-023-08439-x.

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Abstract Background Osler’s nodes, Janeway lesions and splinter haemorrhages are cutaneous manifestations of infective endocarditis. They occur due to vascular occlusion by septic emboli and a resulting localized vasculitis. They are usually bilateral. We report a case of unilateral Osler’s nodes, Janeway lesions and splinter haemorrhages due to an ipsilateral surgical arterio-venous fistula infection. Case presentation A fifty-two-year-old Sri Lankan female with end stage kidney disease presented with fever for five days with blurred vision, pain and redness of the right eye. She had a left brachio-cephalic arterio-venous fistula (AVF) created one month back. She complained of a foul-smelling discharge from the surgical site for past three days. Redness of the right eye with a hypopyon was noted. AVF site over the left cubital fossa was infected with a purulent discharge. Osler’s nodes, Janeway lesions and splinter haemorrhages were noted in the distal fingers, thenar and hypothenar eminences of the left hand. Right hand and both feet were normal. No cardiac murmurs were heard. Blood cultures, vitreous sample cultures and pus cultures from the fistula site were all positive for methicillin sensitive Staphylococcus aureus. Infective endocarditis was excluded by a trans-oesophageal echocardiogram. She was treated with IV flucloxacillin and surgical excision of the AVF. Conclusion Infections of AVF can result in septic emboli formation which can have both anterograde arterial embolization and retrograde venous embolization. Arterial embolization can result in unilateral Osler’s nodes, Janeway lesions and splinter haemorrhages. Venous embolization can cause metastatic infections in the systemic and pulmonary circulations.
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Bürgisser, Nils, Jérémy Cendan, Christian Hulo, Angela Huttner, and Jacques Serratrice. "Unilateral Osler nodes and Janeway lesions: look beyond the heart." American Journal of Medicine, May 2025. https://doi.org/10.1016/j.amjmed.2025.05.019.

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