Osler's nodes

Osler's nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, but are most commonly seen in patients with infective endocarditis. The nodes are named after Sir William Osler, a Canadian physician and one of the founding professors of Johns Hopkins Hospital.

History

William Osler first described these nodes in 1885 in patients with infective endocarditis. He noted that they were painful, raised lesions that typically occurred on the fingers and toes. Osler's nodes, along with Janeway lesions, are one of the classic peripheral stigmata of endocarditis.

Clinical Presentation

Osler's nodes present as painful, red or purple, raised lesions on the hands and feet. They are typically located on the pads of the fingers and toes, but can also be found on the thenar and hypothenar eminences of the palms, and soles of the feet. The nodes are usually 1-2 cm in diameter and may be surrounded by an erythematous halo. They are transient, often disappearing within hours to days.

Pathophysiology

The exact pathophysiology of Osler's nodes is not fully understood. It is believed that they are caused by the deposition of immune complexes in the dermal capillaries, leading to an inflammatory response. This is supported by the fact that they are often associated with conditions that result in high levels of circulating immune complexes, such as infective endocarditis and systemic lupus erythematosus.

Diagnosis

The diagnosis of Osler's nodes is primarily clinical, based on their characteristic appearance and association with other signs of endocarditis. However, they can be difficult to distinguish from other similar lesions, such as Janeway lesions and Roth spots. Unlike Janeway lesions, Osler's nodes are painful and have a more raised appearance.

Treatment

Treatment of Osler's nodes involves addressing the underlying condition causing them. In the case of infective endocarditis, this typically involves long-term antibiotic therapy. In some cases, surgical intervention may be required to repair or replace damaged heart valves.

See Also

• Infective endocarditis
• Janeway lesions
• Roth spots
• William Osler