Osler's node
{{short description|Painful raised skin lesions of the hands and feet}}
{{distinguish|Janeway lesion}}
{{for|other Osler's signs|Osler's sign (disambiguation)}}
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|caption = Osler's lesions found on the hand and fingers of a 43-year-old male with subacute bacterial endocarditis
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|differential = infective endocarditis
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Osler's nodes are painful, red, raised lesions found typically on the hands and feet.{{cite journal |last1=Parashar |first1=Krishan |last2=Daveluy |first2=Steven |title=Osler Node and Janeway Lesions |journal=StatPearls |date=2022 |pmid=32491553 |url=https://pubmed.ncbi.nlm.nih.gov/32491553/ |publisher=StatPearls Publishing }} They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition. Their presence is one definition of Osler's sign.{{DorlandsDict|seven/000097190|Osler sign}}
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Causes
Osler's nodes result from the deposition of immune complexes.{{cite journal|last1=Farrior|first1=JB|last2=Silverman|first2=ME|title=A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis|journal=Chest|volume=70|issue=2|pages=239–43|date=August 1976|url=http://journal.publications.chestnet.org/data/Journals/CHEST/20983/239.pdf|pmid=947688|doi=10.1378/chest.70.2.239}} The resulting inflammatory response leads to swelling, redness, and pain that characterize these lesions.
The nodes are commonly indicative of subacute bacterial endocarditis.{{DorlandsDict|six/000072701|Osler nodes}} 10–25% of endocarditis patients will have Osler's nodes.{{cite web |url=https://www.lecturio.com/concepts/endocarditis/| title=Endocarditis
|website=The Lecturio Medical Concept Library |access-date= 19 July 2021}} 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's nodes can also be seen in
- Systemic lupus erythematosus
- Marantic endocarditis
- Disseminated gonococcal infection
- Distal to infected arterial catheter
Etymology
Osler's nodes are named after Sir William Osler who described them in the early twentieth century.{{WhoNamedIt|synd|1702}}{{cite journal|last=Osler|first=W|title=Chronic infectious endocarditis|journal=Quarterly Journal of Medicine|year=1908–1909|volume=2|pages=219–230|publisher=Oxford}} He described them as "ephemeral spots of a painful nodular erythema, chiefly in the skin of the hands and feet."