A 45-year-old man with subacute infective endocarditis has a low-grade fever and tender nodules on the pads of his fingers. Blood cultures grow Streptococcus viridans. The finger nodules differ from the macular hemorrhagic lesions sometimes seen on his palms in that they:
- A Are painless and result from septic emboli
- B Are painful and result from immune complex deposition ✓
- C Are painless and result from cholesterol crystal emboli
- D Are painful and represent direct extension of valvular infection
Correct answer: B. Are painful and result from immune complex deposition
Explanation
Osler nodes are painful, erythematous nodules on finger and toe pads caused by immune complex deposition with local vasculitis. Janeway lesions, the palmar macules described here, are painless hemorrhagic lesions produced by septic microemboli. This immunologic versus embolic distinction is the classic discriminating fact. Roth spots are retinal hemorrhages with pale centers, another immune-complex manifestation, supporting choice B over all others.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.