Osler node

Not to be confused with Janeway lesion.

For other Osler's signs, see Osler's sign (disambiguation).

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

Osler nodes are named for Sir William Osler.

Causes

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

The nodes are commonly indicative of subacute bacterial endocarditis. 10–25% of endocarditis patients will have Osler's nodes. 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.

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. He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet."

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