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Janeway Lesions in Endocarditis seen on Physical Exam 

Dr Supradip Ghosh
@dr_supradip

36 year old male with history
left hemiplegia, fevers ... sister shared these photos ... with persistent fever ... - Clinical examination ... #photo #dermatology
Fever Patterns - Differential Diagnosis Framework

Continuous Fever:
Temp > 38°C with only 1 degree fluctuation in 24
Acute bacterial endocarditis ... • Infective endocarditis ... • Gonococcal endocarditis ... Non-Infectious Causes ... Sub-acute infective endocarditis
Differential Diagnosis of Fever and Splenomegaly
 - Typhoid
 - Infective endocarditis
 - Miliary tuberculosis
 - Hodgkin
Differential Diagnosis of Fever ... - Infective endocarditis ... Brucellosis #Fever ... Differential #Diagnosis #causes
Systolic Murmurs - Differential Diagnosis Algorithm
Benign / Flow / Hyperdynamic:
 • Pregnancy
 • Fever
 • Anemia
Supravalvular
Pregnancy • Fever ... • Rheumatic Fever ... • Rheumatic Fever ... • Rheumatic Fever ... Diagnosis #Algorithm #causes
Faget's Sign & Liebermeister's Rule
Pulse-Temperature Dissociation
EVERY 1 F RISE IN TEMPERATURE -> HR INCREASES 8-10 BPM
INFECTIOUS
• Typhoid Fever ... • Drug Fever ... CLINICAL UTILITY ... Typhoid Fever (S ... Dengue Fever NOTE
Primary and Secondary Causes of Mitral Regurgitation
Primary (organic) chronic mitral regurgitation:
 • Leaflet: Rheumatic fever, Infective
and Secondary Causes ... Leaflet: Rheumatic fever ... tendineae: Rheumatic fever ... annulus: Rheumatic fever ... #causes #primary
Causes of Fever of Unknown Origin (FUO) - Differential Diagnosis
 • Infection: Extrapulmonary tuberculosis, Abscess, Endocarditis,
Causes of Fever ... tuberculosis, Abscess, Endocarditis ... Brucellosis, Q fever ... Mediterranean fever ... , Factitious fever
Causes of Fever of Unknown Origin (FUO) - Differential Diagnosis Algorithm
Neoplasm:
• NHL
• Hodgkin's lymphoma
• Leukemia
• Solid
Causes of Fever ... Other: • Drug fever ... • Factitious fever ... • Infectious endocarditis ... • Rheumatic fever
Vasculitis: In this instance, the vasculitic skin lesions were secondary to Haemophilus endocarditis.
Photo credit, Josh Fierer,
to Haemophilus endocarditis ... Photo credit, Josh ... UCSD Catalog of Clinical ... Images #Clinical ... #Photo #Dermatology
Janeway Lesion: Flat, painless, erythematous lesions seen on the palm of this patient's hand. While
frequently associated
with bacterial endocarditis ... , in this case, ... Photo credit, Josh ... Images #Clinical ... #Photo #Dermatology