Osler nodes

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.


 * 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

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
 * TTP - schistocytes on blood smear, increased LDH & indirect bilirubin
 * ITP - platelet-associated IgG test


 * Urinalysis

Chest X Ray

 * X-ray for septic emboli

Echocardiography or Ultrasound

 * Echo for endocarditis and valvular disorders

Acute Pharmacotherapies

 * Meningococcemia - IV antibiotics, antibiotic prophylaxis

Chronic Pharmacotherapies

 * Bacterial endocarditis - Long term antibiotics

Indications for Surgery

 * Bacterial endocarditis - valve replacement (subjective)