Osler nodes
| Osler nodes |
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Overview
Osler node is a characteristic of subacute bacterial endocarditis. It is small, papulopustular/nodular & tender cutaneus lesion. There is controversy about the exact origin of the lesion.
Differential Diagnosis
In alphabetical order. [1] [2]
- Acute bacterial endocarditis
- Cutaneous vasculitis
- Disseminated intravascular coagulation
- Enteroviral infection
- Idiopathic thrombocytopenia purpura
- Meningococcemia
- Rocky mountain spotted fever
- Subacute bacterial endocarditis
- Syphillis
- Systemic lupus erythematosus
Diagnosis
Physical examination
Heart
- New murmer may suggest infective endocarditis
Laboratory Findings
- Labs include:
- ANA
- anti-dsDNA
- anti-SM antibodies
- Biopsy of lesions
- Blood cultures
- CBC
- Coagulation studies
- Peripheral smear
Chest X Ray
- X-ray for septic emboli
Echocardiography or Ultrasound
- Echo for endocarditis and valvular disorders
Treatment
Acute Pharmacotherapies
- Meningococcemia - IV antibiotics, antibiotic prophylaxis
Chronic Pharmacotherapies
- Bacterial endocarditis - Long term antibiotics
Indications for Surgery
- Bacterial endocarditis - valve replacement (subjective)