Janeway lesions with inconspicuous histological features

Abstract

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.

Acute bacterial septic vasculopathy

“…39 Emboli and direct invasion of blood vessels present as generalized maculopapular lesions, which evolve rapidly, or as widespread purpuric lesions. Septic embolization can cause Osler's node, Janeway lesions, [40][41][42][43] petechiae, and splinter hemorrhages. 44 We found that the most frequent cutaneous signs were purpuric nonblanching lesions and petechiae.…”

Púrpura fulminans relacionada con deficiencia de antitrombina III en paciente agudo críticamente enfermo con aislamiento de Enterococcus faecalis

“…19 Existen otras variantes en la presentación clínica de la trombosis relacionada con Enterococcus faecalis, como la manifestación de la enfermedad séptica embólica a nivel pulmonar con presencia de infartos cutáneos, donde su patrón histológico evidencia dilatación de pequeños vasos con eritrocitos extravasculares a través de la dermis y presencia de trombos de fibrina, ocluyendo los vasos. 20 También se han descrito casos de microangiopatía trombótica con progresión desde el riesgo de injuria renal hasta la pérdida de la función glomerular en pacientes con aislamientos de Enterococcus faecalis en…”

Cutaneous lymphohistiocytic infiltrates with foamy macrophages: A novel histopathological clue to Stenotrophomonas maltophilia septicemia

“…1 Cutaneous septic vasculitis may be observed secondarily to different bacterial infections, including Neisseria meningitidis, Neisseria gonorrhoeae, Pseudomonas aeurignosa, Staphylococcus aureus, as well as certain rickettsioses. [1][2][3][4][5][6][7][8] Depending on the infectious agent, the temporal evolution of the infection (acute vs subacute/chronic), and the host immune status, the ensuing histopathological picture may vary, featuring different combinations of (a) inflammatory leukocytoclastic vasculitis, (b) occlusive thrombosis of small vessels, and (c) subepidermal or intraepidermal pustulation. 1,3,5 The term "septic vasculopathy" has been used for cases showing vascular occlusive phenomena prevailing over the inflammatory vasculitic component.…”

“…The best‐known cutaneous manifestation of septicemia in the skin is the so‐called “septic vasculitis,” a variant of small‐vessel vasculitis characterized by marked vascular damage induced by circulating pathogens and widespread thrombotic changes 1 . Cutaneous septic vasculitis may be observed secondarily to different bacterial infections, including Neisseria meningitidis , Neisseria gonorrhoeae , Pseudomonas aeurignosa , Staphylococcus aureus , as well as certain rickettsioses 1‐8 . Depending on the infectious agent, the temporal evolution of the infection (acute vs subacute/chronic), and the host immune status, the ensuing histopathological picture may vary, featuring different combinations of (a) inflammatory leukocytoclastic vasculitis, (b) occlusive thrombosis of small vessels, and (c) subepidermal or intraepidermal pustulation 1,3,5 .…”