A 48-Year-Old Man With Swollen, Painful Areas on His Thumbs

Andrew Melone, MD; David F. Baehren, MD


January 06, 2020


The lesions depicted in the photographs are Osler nodes. The nodes coupled with the clinical history were suspicious for infective endocarditis (IE). Medical records were obtained while the patient was undergoing evaluation in the ED. During his recent admission for these symptoms, he was told that he had endocardial vegetations and was treated with antibiotics, but he left the hospital against medical advice. Given his recent evaluation, subjective fevers, and the physical finding of Osler's nodes, he was admitted for treatment of IE.

The incidence of IE ranges from 2.4 to 11.9 cases per 100,000 patient years.[1] Of these, half occur in patients aged 31-60 years. It is much more common in patients with preexisting cardiac structural anomalies or with other risk factors, such as injection drug use, prosthetic cardiac valves, or indwelling intravenous catheters. Native-valve IE occurs in 59% to 70% of cases, whereas prosthetic valve IE occurs in 14% to 30% of the time. IE associated with injection drug use accounts for 11% to 16% of cases.[1]


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