Which of the following statements about Janeway lesions is true?

• A. They are painless erythematous macules on palms and soles.
• B. They are painful nodules on fingertips.
• C. They occur only in the retina.
• D. They indicate valve calcification.

Answer: (A)

Janeway lesions are painless erythematous (often hemorrhagic) macules on the palms and soles that occur with infective endocarditis. Their painless nature and location reflect microembolic phenomena from infected valves causing skin microabscesses. This differs from Osler nodes, which are painful nodules on the finger or toe pads due to immune complex deposition. They aren’t retinal lesions—that would be Roth spots—and they don’t indicate valve calcification, which is a different valvular issue. So the statement describing painless erythematous macules on the palms and soles accurately captures Janeway lesions.