Nauman Ismat Butt Azra Naheed Medical College, Superior University Lahore Pakistan https://orcid.org/0000-0003-1022-0157 Barak Waris Chaudhary Muhammad Akram Teaching & Research Hospital, Azra Naheed Medical College, Superior University Lahore Pakistan Ayman Bashir Chaudhary Muhammad Akram Teaching & Research Hospital, Azra Naheed Medical College, Superior University Lahore Pakistan Imania Khizar Chaudhary Muhammad Akram Teaching & Research Hospital, Azra Naheed Medical College, Superior University Lahore Pakistan Ayesha Afzal Chaudhary Muhammad Akram Teaching & Research Hospital, Azra Naheed Medical College, Superior University Lahore Pakistan

Keywords: Janeway lesions, Infective endocarditis, Septic embolism, Staphylococcus aureus, Vancomycin

Abstract

We present the case of a 17-year-old female who developed Janeway lesions as a cutaneous manifestation of infective endocarditis caused by Staphylococcus aureus. The patient presented with a 7-day history of high-grade fever, chills, body aches, palpitations, and exertional shortness of breath. Physical examination revealed multiple purplish-red, non-itchy macules on both hands and left foot, consistent with Janeway lesions. Cardiovascular examination demonstrated a grade 4 pan-systolic murmur at the mitral area and a grade 4 early diastolic murmur at the aortic areaBlood cultures identified Staphylococcus aureus, sensitive to vancomycin and gentamycin. Transthoracic echocardiography revealed vegetations on the mitral valve and moderate-to-severe mitral regurgitation. Fundoscopy did not reveal Roth’s spots, and tests for ANA, HBV, HCV and HIV were negative. The patient was diagnosed with infective endocarditis and started on intravenous vancomycin and gentamycin, showing clinical improvement. She was discharged on vancomycin to complete a 6-week course of treatment. This case underscores the importance of recognizing cutaneous signs, such as Janeway lesions, which can aid in the early diagnosis of infective endocarditis and guide appropriate treatment.

Abbreviations: ANA: Antinuclear Antibody, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, LFTs: liver function tests, PML: posterior mitral leaflet, RFTs: renal function tests, TLC: total leukocyte count,

Keywords: Janeway Lesions; Infective Endocarditis; Septic Embolism; Staphylococcus Aureus; Vancomycin

Citation: Waris B, Butt NI, Bashir A, Khizar I, Afzal A. Janeway lesions in infective endocarditis: an old clinical sign revisited. Anaesth. pain intensive care 2025;29(4):442-445. DOI: 10.35975/apic.v29i4.2684

Received: February 14, 2025; Revised: June 12, 2025; Accepted: June 25, 2025