Janeway lesions with inconspicuous histological features.
Septic-embolic diseases are life threatening; survival critically depends on rapid diagnosis. Clinically, cutaneous manifestations like Janeway lesions are infrequently occurring but highly characteristic. In contrast, histological features are not clearly defined. We report the case of a 59-year-old male patient in deteriorating general condition and fever of unknown origin with lesions suggestive for Janeway lesions. Histology showed dilated blood vessels and extravasated erythrocytes throughout the dermis. Only serial sections revealed single, deep dermal vessels occluded by fibrin thrombi. Computed tomography scan identified multiple pulmonary round masses. Blood cultures showed growth of Staphylococcus aureus and Enterococcus faecalis. The knowledge of the described subtle histological features and a clinical-pathological correlation is essential for the diagnosis of certain cases of septic-embolic conditions.
Loewe
Robert
R
Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. robert.loewe@meduniwien.ac.at
Gattringer
Klaus B
KB
Petzelbauer
Peter
P
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001808:Blood Vessels / Q000473:pathology; D004617:Embolism / Q000382:microbiology / Q000473:pathology; D013293:Enterococcus faecalis; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D012867:Skin / Q000098:blood supply / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology / Q000382:microbiology / Q000473:pathology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination