Osler's nodes are painful, red or purple, raised lesions typically found on the pads of the fingers and toes. These lesions are considered a classic sign of infective endocarditis, a serious infection of the heart's inner lining, typically involving the heart valves. Osler's nodes are thought to result from immune complex deposition in the skin's small blood vessels, leading to a localized inflammatory response. Unlike Janeway lesions, which are also associated with infective endocarditis but are painless, Osler's nodes are characterized by tenderness and pain, which can help in differentiating between the two. The primary cause of Osler's nodes is the immune response triggered by the infective endocarditis. This infection is most commonly caused by bacteria such as Staphylococcus aureus or Streptococcus species, which enter the bloodstream and attach to the heart valves, forming vegetations. These vegetations can release emboli and immune complexes, which then lodge in small vessels of the skin, particularly in the fingers and toes, leading to the formation of Osler's nodes.
Treatment of Osler's nodes focuses on the underlying infective endocarditis. This involves prompt initiation of appropriate antibiotic therapy, often requiring several weeks of intravenous antibiotics tailored to the specific pathogen identified through blood cultures. In cases where the infection does not respond to antibiotics or if there is severe valve damage, surgical intervention may be necessary to repair or replace the affected valve. Osler's nodes typically resolve with the effective treatment of the underlying infection and do not require direct treatment themselves. Pain management may be necessary to alleviate discomfort while the infection is being treated.
