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March 2010

Janeway Lesions, Osler Nodes, or Neither?—Reply

Author Affiliations

Author Affiliations: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York (Dr DeAngelis), and Weill Cornell Medical College (Dr Navi), New York, New York.

Arch Neurol. 2010;67(3):373. doi:10.1001/archneurol.2010.9

In reply

We thank Dr Kittisupamongkol for his interest in our article.1 While our patient was aphasic, she did not grimace, moan, or withdraw to palpation of the lesions, so there appeared to be no discomfort associated with them, making them Janeway lesions. Janeway lesions and Osler nodes are often thought to be pathognomonic for infective endocarditis. However, they are manifestations of distal cutaneous vascular insufficiency, which can occur from emboli from any source, including tumor and nonbacterial thrombotic endocarditis or vascular inflammation due to immune complex deposition as a consequence of chronic bacterial infection.2,3

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