Osler's nodes are small, tender subcutaneous nodules that develop in the pulp of the digits or occasionally more proximally in the fingers and persist for hours to several days. These too are not pathognomonic for IE.
Janeway lesions are small erythematous or hemorrhagic macular nontender lesions on the palms and soles and are the consequence of septic embolic events.
Roth spots, oval retinal hemorrhages with pale centers, are infrequent findings in patients with IE.
The hallmarks of IE are fever and new murmur (over 85 per cent). However, fever may be absent in the elderly and the uremic or immunosuppressed population. Murmurs may be absent with right sided or mural infections or intracardiac device infection.
Systemic emboli are among the most common clinical sequelae of IE. Emboli often antedate diagnosis. Although embolic events may occur during or after antimicrobial therapy, the incidence decreases promptly during administration of effective antibiotic therapy. Embolic splenic infarction may cause left upper quadrant abdominal pain and left shoulder pain. Renal emboli may occur asymptomatically or with flank pain and may cause gross or microscopic hematuria. Embolic stroke syndromes, predominantly involving the middle cerebral artery territory, occur in 15 to 20 per cent of patients with NVE and PVE. Coronary artery emboli are common findings at autopsy but rarely result in transmural infarction. Emboli to the extremities may produce pain and overt ischaemia, and those to mesenteric arteries may cause abdominal pain, ileus, and guaiac positive stools.