Pathophysiology of Janeway lesions!

[HazomboL]

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Hi guys..
I came across this question in USMLE world that asked about the pathophysiology of Janeway lesions. It explained that Janeway and Osler's (of SBE) are due to septic emboli.. I have done step 2 previously, and remember that they were due to immune complex deposition. Septic emboli do occur in SBE, but are not responsible for these pathognomonic lesions. The question made me check out that issue on wikipedia (not a medical source, but still).. and it confirmed what I was thinking. However, the question seemed to be clear and adamant and other sources did not state clearly the pathogenesis of the lesions..

Do you have a clue?

 

[McGillGrad]

It is not been determined exactly what they are, so your best source would be uptodate.com to confirm/cite using recent research.

 

[majik1213]

my understanding is in endocarditis, fragments of the bacterial-infected cells (or just the cell surface antigen-Ab immune complexes ) break off from the heart tissue and travel systemically. Once they enter the tiny capillaries, they become stuck in the tiny radius. I think this may exemplify septic emboli, but I must admit you raise a valid point. Still, I could see it as septic because it relates to infection (S. viridans most likely), and as an emboli in the sense that a thrombotic-inducing complex has dislodged from the heart and traveled to the capillaries where it became stuck. I'm interested to know what the answer choices were in the problem.

 

[robmcc1]

I just had the same question - the options are 1. Immune complex mediated vascular lesions or 2. Microemboli to skin vessels.

Very confusing as the sources I had read also stated that janeway lesions are immune-complex mediated

 

[McGillGrad]

I just had the same question - the options are 1. Immune complex mediated vascular lesions or 2. Microemboli to skin vessels.

Very confusing as the sources I had read also stated that janeway lesions are immune-complex mediated

On the boards they generally defer to Robbins and other med school heavy reference books.

 

[DrTacoElf]

so whats the consensus here on Osler Node and Janeway Lesions --- microemboli and not immune complex?

Roth spot, splinter hemorrhage = microemboli also?

 

[kryptik]

Janeway are a result of microembolism of the extremeties, nodules i have no idea

 

[healingpower]

looking it up in goljan page 183

they state that there are both immune complex vasculitis as well as microembolization

under immune complex vasculitis comes
a. glomerulonephritis
b. Roth spots

under microembolization
a. splinter hemmorhages
b.janeway lesions
c. osler nodes
d. mucosal petechia
e.infarctions in different tissue sites....

copied all straight from goljan 3rd edition
hope that clears up things.