Osler nodes and Janeway lesions are clinical clues to which condition?

• A. Tetanus
• B. Infective endocarditis
• C. Meniere disease
• D. Rheumatic fever

Answer: (B)

Osler nodes and Janeway lesions are clues pointing to infective endocarditis, an infection of the heart valves. Osler nodes are tender, raised nodules on the fingertips or toes caused by immune complex–mediated vasculitis. Janeway lesions are painless, flat, erythematous lesions on the palms or soles produced by septic emboli from the infected valve. Seeing these skin findings alongside fever or a new or changing heart murmur strongly suggests infective endocarditis because they reflect the two main processes at play: immune-mediated phenomena and embolic phenomena from the infected valve. Other conditions don’t produce this combination of findings—the signs aren’t typical of tetanus (muscle rigidity and locked jaw), Menière disease (vertigo and hearing loss), or rheumatic fever (migratory arthritis with carditis but not these skin lesions).