Which finding is associated with bacterial endocarditis?

• A. Osler's Nodes
• B. Janeway Lesions
• C. Splinter Hemorrhages on Nails
• D. Petechiae on Palms

Answer: (C)

In infective endocarditis, vegetations shed tiny emboli and cause vascular damage in multiple tissues. Splinter hemorrhages under the nails are tiny linear hemorrhages from these microemboli or local vasculitis in the nail bed—a classic peripheral sign of endocarditis that clinicians often notice on exam. Other findings like Osler's nodes (painful nodules from immune complex deposition) and Janeway lesions (painless hemorrhagic spots on the palms/soles from septic emboli) also occur with endocarditis, but nail bed hemorrhages specifically reflect microvascular bleeding associated with the condition. Petechiae on the palms can occur too, but splinter hemorrhages are the most characteristic nail-related sign.