Which finding is classically described as small, linear red or brown streaks under the nails?

• A. Splinter hemorrhages under the nails
• B. Janeway lesions on palms and soles
• C. Osler nodes on fingertips
• D. Roth spots in retina

Answer: (A)

Splinter hemorrhages are tiny linear red to brown streaks that run under the nail plate. They occur from small capillary hemorrhages in the nail bed, commonly due to microemboli or vasculitis associated with infective endocarditis. Their distinctive straight, streak-like appearance is what makes them classic for this condition. In a patient with fever, a new heart murmur, or positive blood cultures, seeing these streaks strongly supports endocarditis workup. Other nail findings—like painless lesions on the palms and soles, tender nodules on fingertips, or retinal hemorrhages with pale centers—help differentiate the other signs, but the described linear under-nail streaks point to splinter hemorrhages.