Osler's Nodes in a patient with infective endocarditis
67yo presents with R occipital intraparenchymal hemorrhage (IPH) attributed to HTN. Pt develops fever and ID is consulted. You pull back the covers and you notice the following image. Lesions are tender. What are you seeing? What’s your ddx?
Blood cultures (+) for MSSA. TTE negative but TEE showed 0.7x0.5cm AoV vegetation, confirming our working diagnosis of endocarditis and raising suspicion for ruptured mycotic cerebral aneurysm.
The picture is an example of embolic phenomena due to endocarditis. The key is looking under the sheets! We typically think of Osler nodes (tender, embolic, typically larger) and Janeway lesions (nontender, immunologic, typically smaller), but there is overlap between the two.
Dr. Nate Warner @NateWarnerMD
#Oslers #Node #infective #endocarditis #clinical #photo #foot