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impaired consciousness &#40;Glasgow Coma Scale score&#44; 12&#41;&#44; and low blood pressure &#40;90&#47;60<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Additional tests ordered in the emergency department revealed leukocytosis with neutrophilia&#44; elevated procalcitonin levels&#44; electrolyte imbalance&#44; and metabolic acidosis&#46; Transthoracic echocardiography did not detect vegetation&#46; The patient was admitted to the intensive care unit with a clinical diagnosis of sepsis of unknown focus &#40;3 points on the quick Sequential Organ Failure Assessment &#40;qSOFA&#41; scale&#44; and empirical antibiotic treatment was prescribed&#46; Subsequently&#44; we requested evaluation due to the appearance of painless skin lesions on the palms&#46; Cutaneous examination revealed millimetric erythematous-violaceous macules with an annular pattern on both hypothenar eminences &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#44; as well as a bleeding longitudinal lesion on the nail of the third finger of the right hand consistent with a splinter hemorrhage&#46; The patient had no plantar involvement&#46; A skin biopsy revealed an inflammatory infiltrate of predominantly polymorphonuclear neutrophils in the papillary dermis forming a microabscess without vasculitis or fibrin emboli &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46; The epidermis and the glomus presented no abnormalities&#46; The Gram stain was negative&#46; These histologic findings supported the diagnosis of Janeway lesions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The culture of 1 of the lesions and blood cultures were negative&#46; Serial transthoracic and transesophageal echocardiography ruled out the presence of endocarditis&#44; and an ophthalmologic examination showed no abnormalities&#46; Laboratory tests showed progressive deterioration of kidney function &#40;creatinine 3&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and the ratio of PaO<span class="elsevierStyleInf">2</span> to the inspired oxygen fraction &#40;&#60;300<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Computed axial tomography later revealed an infectious pulmonary focus&#44; and&#44; following bronchoscopy&#44; <span class="elsevierStyleItalic">Enterobacter asburiae</span> and <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> were isolated in the bronchoalveolar lavage&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on clinical and histologic findings and additional test results&#44; we established a final diagnosis of sepsis of respiratory origin &#40;qSOFA&#44; 4 points&#41; with associated Janeway-like lesions&#46; The skin lesions resolved in a few days&#44; but the patient developed multiple complications and died 4 months after admission&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Janeway lesions&#44; together with Osler nodes&#44; constitute the main skin manifestation of infective endocarditis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> Traditionally&#44; Osler nodes have been associated with subacute cases and Janeway lesions with acute cases of endocarditis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a> Their prevalence ranges from 5&#37; to 15&#37; in infective endocarditis&#44; although this figure may be an underestimation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The exact pathogenesis of skin lesions associated with infective endocarditis is still debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> Clinically&#44; Janeway lesions are characterized by small&#44; painless erythematous macules and are located on the palms and soles&#46; They may last from days to weeks and disappear leaving no residual lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#8211;6</span></a> Classic histologic findings include the presence of dermal microabscesses with no signs of vasculitis&#44; although recent publications argue that diverse histologic patterns are possible&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a>Microbiology cultures are not always positive&#46; While such lesions were initially described in connection with infective endocarditis&#44; their presence is not limited to this disease alone&#46; In recent years&#44; cases of Janeway-like lesions have been reported in staphylococcus septicemia &#40;2 cases&#41; and following endovascular procedures &#40;2 cases&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#8211;10</span></a> Infective endocarditis was reasonably ruled out in all those cases&#46; Our report of these lesions in a patient with a non-staphylococcus respiratory infection can be included in this group of Janeway-like lesions not associated with infective endocarditis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We present the first case described to date of Janeway-like lesions secondary to a respiratory infection&#46; When such lesions are observed&#44; we think it important to consider possible infectious causes other than infective endocarditis and to investigate a possible history of a recent endovascular procedure&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic findings of a biopsied lesion showed dermal but no epidermal abnormalities&#46; &#40;A&#41; Superficial dermal neutrophilic focal infiltration forming poorly defined microabscesses with no signs of vasculitis &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;100&#41;&#46; &#40;B&#41; Further enlargement &#40;original magnification &#215;200&#41; confirmed the absence of vasculitis and also identified mild karyorrhexis and isolated eosinophils&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microbiologic studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Additional tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reddy et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythematous macules&#44; papules&#44; and vesicles on palms and soles&#46;Fever&#44; dyspnea&#44; and productive cough&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidermal necrosis&#44; neutrophilic abscess in reticular dermis with the presence of gram-positive coccobacilli in the center&#46; No signs of vasculitis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus aureus</span> resistant to methicillin in sputum&#44; blood&#44; and skin cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest X-ray&#58; bilateral lower lobe consolidations&#46; Transthoracic and transesophageal echocardiography negative&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to staphylococcal septicemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yamamoto et al&#46; &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painless reddish-blue spots on palms and soles&#44; subconjunctival bleeding&#44; and erythema with scaling on the scalp and limbs&#46;General malaise and fever&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S aureus</span> sensitive to methicillin in blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Staphylococcal septicemia secondary to psoriatic erythroderma with associated Janeway-like lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mathes et al&#46; &#40;2016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple erythematous macules and papules on the right hand upon removal of the right radial arterial catheter inserted for blood pressure monitoring&#46;No systemic symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin culture&#58; <span class="elsevierStyleItalic">S aureus</span> sensitive to methicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasound&#58; pseudoaneurysm of the radial artery with extravasation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to infected radial aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hern&#225;ndez-Ram&#237;rez et al&#46; &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions on the sole of the left foot 1 month after bypass of the left femoral vessels during heart surgery for extracorporeal membrane oxygenation&#46;Fever&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood and skin cultures&#58; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transesophageal and transthoracic echocardiography&#58; no signs of endocarditis&#46;Computed tomography&#58; pseudoaneurysm of the left femoral artery&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localized Janeway-like lesions following extracorporeal membrane oxygenation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Our case &#40;2021&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythematous-violaceous annular macules on hypothenar eminences&#44; bleeding longitudinal on the third finger of the right hand&#46; No plantar involvement&#46;General malaise&#44; fever&#44; and shivering&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polymorphonuclear neutrophils forming a microabscess in the papillary dermis&#46; No signs of vasculitis or fibrin emboli&#46; Epidermis and glomus with no abnormalities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood and skin cultures&#58; negative&#46;Culture of bronchoalveolar lavage fluid&#58; <span class="elsevierStyleItalic">Enterobacter asburiae&#44; Klebsiella pneumoniae&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transthoracic and transesophageal echocardiography&#58; no signs of endocarditisComputed tomography&#58; lung infection&#46;Ophthalmologic study&#58; no abnormalities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to a respiratory infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of Janeway-Like Lesions With No Signs of Endocarditis&#46;</p>"
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      "titulo" => "References"
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          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Splinter haemorrhages&#44; Osler&#39;s nodes&#44; Janeway lesions and Roth spots&#58; the peripheral stigmata of endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Sethi"
                            1 => "J&#46; Buckley"
                            2 => "J&#46; de Wolff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Hosp Med"
                        "fecha" => "2013"
                        "volumen" => "74"
                        "paginaInicial" => "139"
                        "paginaFinal" => "142"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectious endocarditis&#58; an update for emergency clinicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Long"
                            1 => "A&#46; Koyfman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2018.06.074"
                      "Revista" => array:6 [
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                        "fecha" => "2018"
                        "volumen" => "36"
                        "paginaInicial" => "1686"
                        "paginaFinal" => "1692"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30001813"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic manifestations of infective endocarditis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;T&#46; Gomes"
                            1 => "L&#46;R&#46; Tiberto"
                            2 => "V&#46;N&#46; Monte Bello"
                            3 => "M&#46;A&#46; Jacometo Lima"
                            4 => "G&#46; Alborgheti Nai"
                            5 => "M&#46;A&#46; Milanez Morgado de Abreu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20164718"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2016"
                        "volumen" => "91"
                        "paginaInicial" => "92"
                        "paginaFinal" => "94"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28300907"
                            "web" => "Medline"
                          ]
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                ]
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            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Osler&#39;s nodes and Janeway lesions are not the result of small-vessel vasculitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;S&#46; Alpert"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2013.04.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "2013"
                        "volumen" => "126"
                        "paginaInicial" => "843"
                        "paginaFinal" => "844"
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Case and Research Letter
Janeway-Like Lesions Associated With Sepsis Secondary to a Respiratory Infection
Lesiones tipo manchas de Janeway asociadas a sepsis de origen respiratorio
N. Moreiras Ariasa,
Corresponding author
noeliama93@hotmail.com

Corresponding author.
, G. Pita da Veigab, J.M. Suárez Peñarandac, M. Pousa Martínezd
a Servicio de Dermatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
b Servicio de Dermatología, Hospital Universitario Lucus Augusti, Lugo, Spain
c Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
d Servicio de Dermatología, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
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      "es" => array:1 [
        "titulo" => "Lesiones tipo manchas de Janeway asociadas a sepsis de origen respiratorio"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical findings&#46; &#40;A and B&#41; Dermatologic examination revealed millimetric annular macules with an erythematous-violaceous coloration on both palms&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Janeway lesions were first described by Edward Janeway in 1899 in patients with infective endocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> At present they are part of the minor diagnostic criteria &#40;modified Duke criteria&#41; for the disease together with other cutaneous manifestations such as Osler nodes&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a> However&#44; in recent decades&#44; cases of Janeway-like lesions have been described in connection with other infectious diseases&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 69-year-old man complained of fever and shivering lasting 24<span class="elsevierStyleHsp" style=""></span>h with no other signs or symptoms but general deterioration of his health&#46; The physical examination showed tachypnea&#44; impaired consciousness &#40;Glasgow Coma Scale score&#44; 12&#41;&#44; and low blood pressure &#40;90&#47;60<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Additional tests ordered in the emergency department revealed leukocytosis with neutrophilia&#44; elevated procalcitonin levels&#44; electrolyte imbalance&#44; and metabolic acidosis&#46; Transthoracic echocardiography did not detect vegetation&#46; The patient was admitted to the intensive care unit with a clinical diagnosis of sepsis of unknown focus &#40;3 points on the quick Sequential Organ Failure Assessment &#40;qSOFA&#41; scale&#44; and empirical antibiotic treatment was prescribed&#46; Subsequently&#44; we requested evaluation due to the appearance of painless skin lesions on the palms&#46; Cutaneous examination revealed millimetric erythematous-violaceous macules with an annular pattern on both hypothenar eminences &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#44; as well as a bleeding longitudinal lesion on the nail of the third finger of the right hand consistent with a splinter hemorrhage&#46; The patient had no plantar involvement&#46; A skin biopsy revealed an inflammatory infiltrate of predominantly polymorphonuclear neutrophils in the papillary dermis forming a microabscess without vasculitis or fibrin emboli &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41;&#46; The epidermis and the glomus presented no abnormalities&#46; The Gram stain was negative&#46; These histologic findings supported the diagnosis of Janeway lesions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The culture of 1 of the lesions and blood cultures were negative&#46; Serial transthoracic and transesophageal echocardiography ruled out the presence of endocarditis&#44; and an ophthalmologic examination showed no abnormalities&#46; Laboratory tests showed progressive deterioration of kidney function &#40;creatinine 3&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and the ratio of PaO<span class="elsevierStyleInf">2</span> to the inspired oxygen fraction &#40;&#60;300<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46; Computed axial tomography later revealed an infectious pulmonary focus&#44; and&#44; following bronchoscopy&#44; <span class="elsevierStyleItalic">Enterobacter asburiae</span> and <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> were isolated in the bronchoalveolar lavage&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on clinical and histologic findings and additional test results&#44; we established a final diagnosis of sepsis of respiratory origin &#40;qSOFA&#44; 4 points&#41; with associated Janeway-like lesions&#46; The skin lesions resolved in a few days&#44; but the patient developed multiple complications and died 4 months after admission&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Janeway lesions&#44; together with Osler nodes&#44; constitute the main skin manifestation of infective endocarditis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> Traditionally&#44; Osler nodes have been associated with subacute cases and Janeway lesions with acute cases of endocarditis&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a> Their prevalence ranges from 5&#37; to 15&#37; in infective endocarditis&#44; although this figure may be an underestimation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The exact pathogenesis of skin lesions associated with infective endocarditis is still debated&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> Clinically&#44; Janeway lesions are characterized by small&#44; painless erythematous macules and are located on the palms and soles&#46; They may last from days to weeks and disappear leaving no residual lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#8211;6</span></a> Classic histologic findings include the presence of dermal microabscesses with no signs of vasculitis&#44; although recent publications argue that diverse histologic patterns are possible&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a>Microbiology cultures are not always positive&#46; While such lesions were initially described in connection with infective endocarditis&#44; their presence is not limited to this disease alone&#46; In recent years&#44; cases of Janeway-like lesions have been reported in staphylococcus septicemia &#40;2 cases&#41; and following endovascular procedures &#40;2 cases&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#8211;10</span></a> Infective endocarditis was reasonably ruled out in all those cases&#46; Our report of these lesions in a patient with a non-staphylococcus respiratory infection can be included in this group of Janeway-like lesions not associated with infective endocarditis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We present the first case described to date of Janeway-like lesions secondary to a respiratory infection&#46; When such lesions are observed&#44; we think it important to consider possible infectious causes other than infective endocarditis and to investigate a possible history of a recent endovascular procedure&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "titulo" => "References"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical findings&#46; &#40;A and B&#41; Dermatologic examination revealed millimetric annular macules with an erythematous-violaceous coloration on both palms&#46;</p>"
        ]
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      1 => array:7 [
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic findings of a biopsied lesion showed dermal but no epidermal abnormalities&#46; &#40;A&#41; Superficial dermal neutrophilic focal infiltration forming poorly defined microabscesses with no signs of vasculitis &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;100&#41;&#46; &#40;B&#41; Further enlargement &#40;original magnification &#215;200&#41; confirmed the absence of vasculitis and also identified mild karyorrhexis and isolated eosinophils&#46;</p>"
        ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microbiologic studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Additional tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reddy et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythematous macules&#44; papules&#44; and vesicles on palms and soles&#46;Fever&#44; dyspnea&#44; and productive cough&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidermal necrosis&#44; neutrophilic abscess in reticular dermis with the presence of gram-positive coccobacilli in the center&#46; No signs of vasculitis&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Staphylococcus aureus</span> resistant to methicillin in sputum&#44; blood&#44; and skin cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest X-ray&#58; bilateral lower lobe consolidations&#46; Transthoracic and transesophageal echocardiography negative&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to staphylococcal septicemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yamamoto et al&#46; &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painless reddish-blue spots on palms and soles&#44; subconjunctival bleeding&#44; and erythema with scaling on the scalp and limbs&#46;General malaise and fever&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S aureus</span> sensitive to methicillin in blood cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Staphylococcal septicemia secondary to psoriatic erythroderma with associated Janeway-like lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mathes et al&#46; &#40;2016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple erythematous macules and papules on the right hand upon removal of the right radial arterial catheter inserted for blood pressure monitoring&#46;No systemic symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin culture&#58; <span class="elsevierStyleItalic">S aureus</span> sensitive to methicillin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasound&#58; pseudoaneurysm of the radial artery with extravasation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to infected radial aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hern&#225;ndez-Ram&#237;rez et al&#46; &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions on the sole of the left foot 1 month after bypass of the left femoral vessels during heart surgery for extracorporeal membrane oxygenation&#46;Fever&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood and skin cultures&#58; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transesophageal and transthoracic echocardiography&#58; no signs of endocarditis&#46;Computed tomography&#58; pseudoaneurysm of the left femoral artery&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localized Janeway-like lesions following extracorporeal membrane oxygenation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Our case &#40;2021&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythematous-violaceous annular macules on hypothenar eminences&#44; bleeding longitudinal on the third finger of the right hand&#46; No plantar involvement&#46;General malaise&#44; fever&#44; and shivering&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polymorphonuclear neutrophils forming a microabscess in the papillary dermis&#46; No signs of vasculitis or fibrin emboli&#46; Epidermis and glomus with no abnormalities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood and skin cultures&#58; negative&#46;Culture of bronchoalveolar lavage fluid&#58; <span class="elsevierStyleItalic">Enterobacter asburiae&#44; Klebsiella pneumoniae&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transthoracic and transesophageal echocardiography&#58; no signs of endocarditisComputed tomography&#58; lung infection&#46;Ophthalmologic study&#58; no abnormalities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Janeway-like lesions secondary to a respiratory infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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