Osler node

Osler node
Osler node on ring finger tip
Differential diagnosis	infective endocarditis

Osler nodes are tender pinky-purple small bumps found typically on the tips of fingers and toes in infective endocarditis.^[1] The centre may appear pale and they may measure around 1cm.^[1] They may appear on the sides of fingers and palms of hands, last up to a day and heal without leaving a mark.^[1] Unlike Janeway lesions, which also occur in endocarditis, Osler nodes are painful with pain typically preceding the appearance of the bumps.^[1]

Osler nodes are named for Sir William Osler.^[2]

Causes

Osler's nodes result from the deposition of immune complexes.^[3] The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions.

The nodes are commonly indicative of subacute bacterial endocarditis.^[4] 10–25% of endocarditis patients will have Osler's nodes.^{[citation needed]} Other signs of endocarditis include Roth's spots and Janeway lesions. The latter, which also occur on the palms and soles, can be differentiated from Osler's nodes because they are non-tender.^[1]

Osler nodes can also be seen in

• Systemic lupus erythematosus
• Marantic endocarditis
• Disseminated gonococcal infection
• Distal to infected arterial catheter

Etymology

Osler nodes are named after Sir William Osler who described them in the early twentieth century.^[2] He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet."^{[citation needed]}

Additional images

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  Osler nodes on index finger

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  Osler node on ring finger

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  Osler lesions found on the hand and fingers of a 43-year-old male with subacute bacterial endocarditis

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  Osler node on ring finger of left hand

References