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Extended Janeway lesions in Enterobacter infective endocarditis: a case report

Fadi Abou Deb1, George Abou Deb2, Badie Alkhouli2

  • 1Faculty of Medicine, Damascus University, Damascus, Syria. fadiaboudeeb2023@gmail.com.

Journal of Medical Case Reports
|November 19, 2025
PubMed

Insights

Janeway lesions, a skin manifestation, can aid in diagnosing infective endocarditis (IE). This case highlights challenges in treating IE caused by Enterobacter species, emphasizing atypical presentations and diagnostic tools.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Dermatology

Background:

  • Infective endocarditis (IE) is a severe heart valve infection with diverse clinical signs.
  • The modified Duke criteria aid IE diagnosis, with Janeway lesions being a key indicator.
  • Janeway lesions are characteristic skin findings in certain IE cases.

Purpose of the Study:

  • To present a case of infective endocarditis diagnosed with the help of Janeway lesions.
  • To discuss the diagnostic challenges and management of IE caused by Enterobacter species.
  • To underscore the significance of recognizing unusual IE manifestations.

Main Methods:

  • A case report of a Middle Eastern male patient in his mid-60s.
  • Inclusion of patient history: ischemic heart disease, diabetes mellitus, chronic kidney disease, and hypertension.
  • Diagnostic confirmation via skin biopsy revealing Janeway lesions.

Main Results:

  • The patient presented with respiratory symptoms and extensive skin lesions.
  • Skin biopsy confirmed Janeway lesions, leading to IE diagnosis.
  • Infective endocarditis was attributed to Enterobacter species.
  • Despite treatment, the patient's condition did not improve.

Conclusions:

  • Recognizing atypical IE presentations, like Janeway lesions, is crucial for diagnosis.
  • Skin biopsy is a valuable tool for diagnosing IE.
  • Effective management strategies are needed for IE caused by uncommon organisms like Enterobacter.
Abstract

Keywords:
Case reportEnterobacterInfective endocarditisJaneway lesionsSkin biopsy

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