COMMON SYMPTOMS OF ENDOCARDITIS

     SPLINTER HEMORRHAGES are subungual, dark red, linear streaks.  The are seen in both acute and subacute forms of disease.  When associated with endocarditis the splinters are located in the proximal portion of the nail bed.  In contrast, splinter hemorrhages secondary to trauma are usually located in the distal portion of the nail bed.  Splinter hemorrhages may also be associated with atrial myxomas, psoriasis, scurvy, and thrombocytopenia.

     PETICHIAE associated with endocarditis are small, nonblanching macules which are located most commonly on the conjuctiva, palate, buccal mucosa, heels, shoulders, arms, legs, and upper chest.  They tend to resolve within two to three days after their initial appearance.  Other etiologies associated with petechiae include bacteremia, rickettsial infections, vasculitis, and thrombocytopenia.

     OSLER’S NODES are tender, purplish red subcutaneous nodules, which may have an associated white center, which last for hours to days.  Frequent sites for Osler’s nodes include the finger and toe pads, sides of the fingers, mucous membranes, forearms, flank, trunk, and dorsum of the feet.  The lesions may be preceded by or associated with pain, burning, pruritus, or paresthesias.  Osler’s nodes may also be associated with systemic lupus erythematosus, marantic endocarditis, hemolytic anemia, typhoid fever, gonococcal sepsis, and infected arterial catheters.

     JANEWAY LESIONS are small nontender hemorrhagic or erythematous macules or nodules.  They are often found on the thenar and hypothenar eminences, fingers, and soles of patients with endocarditis.  There is no associated pain with these lesions unlike Osler’s nodes which are painful.  The generally last for several days before resolving.

     ROTH’S SPOTS, also known as Litten’s sign, are pale-centered oval retinal hemorrhages.  They are often located in close proximity to the optic disc.  Other conditions associated with the development of Roth’s spots include collagen vascular diseases, hematologic disorders, and certain infections (kala-azar, psittacosis, and typhoid fever).