A patient with subacute infective endocarditis develops tender, pea-sized nodules on the pulps of his fingers. How do these lesions differ from Janeway lesions?

• A They are painless and arise from septic microembolisation of the dermis
• B They are haemorrhagic and confined to the nail bed
• C They are painful and arise from immune complex deposition in the dermis ✓
• D They are sterile vegetations located on the ventricular endocardium

Explanation

Osler nodes are tender, erythematous nodules on finger or toe pulps caused by immune complex deposition with localised vasculitis, whereas Janeway lesions are painless, haemorrhagic macules on the palms and soles caused by septic microemboli. This pain versus painlessness and immunologic versus embolic distinction is the classic discriminator asked in examinations. Roth spots and splinter haemorrhages are separate immunologic and microembolic findings respectively.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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