Janeway Lesions in Systemic Lupus Erythematosus

Abstract

A 19-year-old male presented with rapidly progressing shortness of breath for three days. He noticed puffiness of face and swelling of feet, developing over three weeks, and some painless reddish lesions on the palms and soles [Image A & B], for two months. Examination revealed "butterfly-rash" on the face, sparing the anti-ds-DNA antibodies were strongly positive, complements (C3 & C4) were low, and there was nephrotic range proteinuria with altered renal function. He was diagnosed as Systemic Lupus Erythematosus (SLE) according to the SLICC classification criteria. 1 Subsequent endocarditis, either infective, or "LibmanSacks" was excluded by trans-esophageal and transthoracic echocardiography and multiple sets of negative blood cultures (aerobic and anaerobic). So the Janeway lesions were attributed to not as peripheral stigma of endocarditis, but as a vasculitic manifestation of SLE. After stabilization and control of acute features, he was referred to the specialized SLE clinic at the medical university for further management. Janeway lesions are erythematous or haemorrhagic nontender macules found on palms and soles, commonly known as a stigma of infective endocarditis (IE).