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Diagnosis of Neoplasia in Barrett&#8217;s Esophagus using Vital-dye Enhanced Fluorescence Imaging
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Janeway lesions with inconspicuous histological features.

Robert Loewe1, Klaus B Gattringer, Peter Petzelbauer

  • 1Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. robert.loewe@meduniwien.ac.at

Journal of Cutaneous Pathology
|February 4, 2009
PubMed
Summary

Rapid diagnosis of septic-embolic disease is crucial. Subtle histological findings, including deep dermal vessel occlusion, aid in diagnosing conditions like Janeway lesions when clinical signs are unclear.

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Area of Science:

  • Pathology
  • Infectious Diseases
  • Dermatology

Background:

  • Septic-embolic diseases pose a significant threat, necessitating prompt diagnosis for improved patient outcomes.
  • Janeway lesions are characteristic but infrequent clinical signs of septic emboli.
  • Histological features of septic-embolic disease, particularly cutaneous manifestations, are not well-defined.

Observation:

  • A 59-year-old male presented with deteriorating health and fever of unknown origin, exhibiting lesions suggestive of Janeway lesions.
  • Histopathological examination revealed dilated dermal blood vessels with extravasated erythrocytes.
  • Serial sectioning identified deep dermal vessels occluded by fibrin thrombi, a subtle but critical finding.

Findings:

  • Computed tomography confirmed multiple pulmonary masses.
  • Blood cultures identified Staphylococcus aureus and Enterococcus faecalis.
  • The study highlights subtle histological indicators of septic emboli in deep dermal vessels.

Implications:

  • Recognizing these subtle histological features is essential for accurate diagnosis of septic-embolic conditions.
  • Clinical-pathological correlation is vital for diagnosing challenging cases.
  • This case underscores the importance of detailed histopathological analysis in suspected septic-embolic disease.