Peripheral Manifestations of Infective Endocarditis

General examination may reveal some classical peripheral manifestations of infective endocarditis. Even though these are becoming rare because of rapid treatment, they may present vital clues in situations where diagnosis is unclear.

Roth Spots

Roth spots are described as ‘canoe-shaped linear haemorrhagic spots with a light central area’. Their aetiology is unclear, but is thought to be related to anoxia leading to increase in venous pressure and rupture.

Image courtesy of C Michael Gibson

Osler’s nodes

Osler’s nodes are painful, erythematous nodules on pads of fingers and toes. They may have a dual aetiology as they are related to both: septic micro-emboli and immune complex related vasculitis. These usually develop late in the illness and may be seen in other conditions like typhoid and gonococcemia. They appear rapidly and resolve without sequelae with treatment.

Image courtesy of C Michael Gibson

Janeway Lesions image

Janeway Lesions are haemorrhagic nodular lesions with an irregular border present on palms and soles. They are related to micro-abscess formation and localised necrosis. Unlike Osler’s nodes, these present early in the disease and are non-tender in nature.

Image courtesy of Charlie Goldberg, M.D.

Splinter haemorrhages

Splinter Haemorrhages are linear minute capillary engorgements usually in distal third of the nail bed. They are usually painless, and though reddish brown to start with turn dark brown or black in a few days. They may be related to other conditions like Psoriasis, meningococcemia or even present in healthy individuals [3].

Image reproduced under the Creatice Commons Licence.

Learning bite

Careful examination of skin, mucosae and fundus is important to pick up peripheral manifestations of endocarditis.