20 Symptoms of Endocarditis to Look Out For

13. Janeway Lesions

Janeway lesions are non-tender, flat or slightly raised red spots usually found on the palms and soles. Unlike Osler’s nodes, they’re painless and are caused by septic microemboli lodging in the skin. Their diagnostic value lies in their specificity to infective endocarditis. Janeway lesions may be missed without a careful skin exam, especially in darker skin tones. These lesions typically appear in acute bacterial endocarditis and signify systemic embolic spread. Their discovery in a patient with fever, murmur, and systemic signs should prompt immediate investigation and empiric antibiotic treatment while cultures are pending.

14. Stroke or Neurological Deficits

A devastating but all-too-common complication of endocarditis is embolic stroke. Vegetations on the heart valves can break off and travel through the bloodstream to the brain, causing sudden neurological symptoms—paralysis, slurred speech, vision changes, or confusion. In fact, stroke may be the presenting symptom of endocarditis in patients with no prior cardiac history. This makes prompt imaging and blood culture essential when a stroke has no clear vascular cause. Any new focal neurological deficit in a patient with signs of infection warrants urgent evaluation for embolic events from endocarditis.