Unilateral Osler Nodes and Janeway Lesions: Look Beyond the Heart

A 46-year-old male presented to the emergency department with a painful, diffusely swollen left leg. His medical history included intravenous drug use and a previous left iliofemoral biosynthetic bypass (Omniflow®) for a left pseudoaneurysm secondary to an arterial infection. On examination, he was febrile at 39.5°C. His left leg was diffusely swollen. On the plantar surface of the foot, multiple erythematous and partially hemorrhagic lesions - both tender and non-tender – as well as petechiae were observed (Figure 1).