What are the other Names for this Condition? (Also known as/Synonyms)

• Osler's Node

What is Osler Node? (Definition/Background Information)

• Osler Nodes are small, raised, and painful skin lesions observed on the hands or feet, which are typically associated with an underlying condition, most commonly infective endocarditis (or bacterial endocarditis). These lesions form due to immune complex depositions beneath the skin
• Infective endocarditis is an infection of the heart valves or the heart’s inner lining, known as the endocardium. It occurs when infection from other parts of the body enter the bloodstream (usually resulting in bacteremia) and attack the lining of the heart or the heart valves
• Osler Nodes may serve as indicators of serious medical illnesses, such as infective endocarditis, and can potentially help the healthcare provider in early diagnosis/treatment of the same. Other rare conditions that Osler Nodes are associated with include systemic lupus erythematosus and disseminated gonococcal infection, among others

Who gets Osler Node? (Age and Sex Distribution)

• Osler Node are observed in individuals with certain medical conditions, chiefly infective endocarditis
• Both males and females may be affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Osler Node? (Predisposing Factors)

The risk factors for Osler Node include:

• Infective endocarditis is the primary predisposing factor for Osler Nodes. According to some studies, between 10-25% of the individuals with endocarditis may present Osler Nodes
• Other diseases and conditions in which these lesions are observed rarely include:
  • Disseminated gonorrhea
  • Hemolytic anemia
  • Infected arterial catheter
  • Non-bacterial thrombotic endocarditis
  • Systemic lupus erythematosus (SLE)
  • Typhoid fever

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Osler Node? (Etiology)

• Osler Nodes may be observed during any phase of infective (bacterial) endocarditis, although most are noted during the subacute phase
• The lesions (Osler Nodes) form as an inflammatory response of skin to deposition of immune complexes (antigen-antibody complexes) beneath the skin

What are the Signs and Symptoms of Osler Node?

The signs and symptoms of Osler Node may include:

• Presence of red to purple lesions with pale centers beneath the skin, on the finger or toe
• Osler Nodes are painful and tender
• These lesions are slightly raised, and their onset is preceded by pain and discomfort
• In most cases, the lesions are present on finger/toe tips or sides. They may also form at the base of the thumb or little finger

Additional signs and symptoms of the underlying condition, such as infective endocarditis, may be noted.

How is Osler Node Diagnosed?

A diagnosis of Osler Node may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Investigative studies to diagnose the underlying condition causing Osler Nodes is important
• Blood tests and culture studies, as needed
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Since Osler Nodes are similar to Janeway lesions, another type of skin lesions that arise from an underlying medical condition (notably infective endocarditis), a differential diagnosis to exclude them may be performed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Osler Node?

There are no significant complications from Osler Nodes. However, complications may be noted from the underlying causative condition, which can be severe and life-threatening.

How is Osler Node Treated?

There is no specific treatment necessary for Osler Nodes; the skin lesions are generally self-resolving. The healthcare provider will undertake appropriate treatment of the underlying condition, such as infective endocarditis, which is important.

How can Osler Node be Prevented?

A prevention of Osler Node is dependent on taking suitable measures to prevent the underlying cause, which includes infective (or marantic) endocarditis, hemolytic anemia, typhoid, disseminated gonococcal infection, or systemic lupus erythematosus.

What is the Prognosis of Osler Node? (Outcomes/Resolutions)

• Osler Nodes are typically self-limited lesions that are known to last for a few hours to days before disappearing completely without scarring (even in the absence of any suitable treatment)
• However, the overall prognosis is based on the promptness of diagnosing the underlying medical condition causing Osler Nodes, and undertaking an appropriate management of the same

Additional and Relevant Useful Information for Osler Node:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/infective-endocarditis/