Which peripheral stigmata are associated with infective endocarditis?

Which peripheral stigmata are associated with infective endocarditis?

• A. Roth spots, Osler nodes, Janeway lesions, splinter hemorrhages
• B. Asterixis
• C. Koplik spots
• D. Petechial conjunctival hemorrhages

Answer: (A)

Infective endocarditis often causes peripheral signs that come from two main processes: immune complex–mediated vessel inflammation and septic emboli from the infected heart valves. The classic peripheral stigmata reflect these mechanisms. Roth spots are white-centered retinal hemorrhages seen on eye exam, produced by microvascular damage with immune complex deposition in the retina. Osler nodes are tender, raised nodules on the fingertips or toes resulting from immune complex–mediated vasculitis in the skin. Janeway lesions are painful on the palms or soles but are typically painless hemorrhagic macules caused by septic emboli from valvular vegetations. Splinter hemorrhages are tiny red-brown lines under the nails from microemboli or vascular injury due to the same infectious process. Other findings like asterixis (a flapping tremor from metabolic issues), Koplik spots (measles), or isolated conjunctival petechiae can occur in various conditions and are not the defining peripheral signs of infective endocarditis.

Infective endocarditis often causes peripheral signs that come from two main processes: immune complex–mediated vessel inflammation and septic emboli from the infected heart valves. The classic peripheral stigmata reflect these mechanisms.

Roth spots are white-centered retinal hemorrhages seen on eye exam, produced by microvascular damage with immune complex deposition in the retina. Osler nodes are tender, raised nodules on the fingertips or toes resulting from immune complex–mediated vasculitis in the skin. Janeway lesions are painful on the palms or soles but are typically painless hemorrhagic macules caused by septic emboli from valvular vegetations. Splinter hemorrhages are tiny red-brown lines under the nails from microemboli or vascular injury due to the same infectious process.

Other findings like asterixis (a flapping tremor from metabolic issues), Koplik spots (measles), or isolated conjunctival petechiae can occur in various conditions and are not the defining peripheral signs of infective endocarditis.