The digital manifestations of subacute bacterial endocarditis

A Variant of Rheumatoid Arthritis resembling Palindromic Rheumatism

“…near the tip of the finger which may be slightly swollen In those first seven cases the nodes were "not beneath but in the skin ", " affecting the digital pads, thenar and hypothenar eminences of the sides of the fingers " with a slightly opaque centre " in all pro--bability caused by minute emboli " (Osler, 1908-9). Blumer (1926) remarks that such nodes '"'have a small brownish stain behind them and occasionally leave a small scab which may be picked off ", a description closely corresponding to the digital nodules of Case 2 in this paper. However, although Keil amongst foity-two cases of subacute bacterial endocarditis has observed a haemorrhagic element with tiny discoloured spots in the depth of the skin, those nodes never suppurated or desquamated.…”

Splinter Hemorrhage

“…Splinter hemorrhages represent rupture of longitudinally oriented nail plate capillaries leading to extravasation and the historical hallmark of linear discoloration. They were first described in 1923 by George Blumer, who described them as “splinters under the nail” in patients with subacute bacterial endocarditis, leading to their commonly taught association in medical and residency education ( 2 ). Most often, however, they are due to trauma, for example, nail biting or using a cane, and manifest distally to the nail ( 2 ).…”

“…They were first described in 1923 by George Blumer, who described them as “splinters under the nail” in patients with subacute bacterial endocarditis, leading to their commonly taught association in medical and residency education ( 2 ). Most often, however, they are due to trauma, for example, nail biting or using a cane, and manifest distally to the nail ( 2 ). Comparatively in systemic diseases, for example, bacterial endocarditis, the splinter hemorrhages develop proximally and occur in multiple nails ( 1 ).…”

Recurrent Osler's Nodes in Systemic Lupus Erythematosus

“…The nodes described by the patient and observed by me were no less than typical with respect to the original description by Sir William Osler in 18938, 9 9 and further observations by others. 3, [10][11][12] The pathogenesis of the Osler node is still unsettled. The question disputed is whether the lesion is secondary to septic or nonseptic embolic phenomena or is a focal vascular reaction.…”

“…The question disputed is whether the lesion is secondary to septic or nonseptic embolic phenomena or is a focal vascular reaction. Attempts to reveal bacteria by histologic and bacteriologic examinations have been thus far unrewarding.3, [13][14][15] Recent evidence suggests the possibility of a focal necrotizing vasculitis of the glomus from the causative organism or its products .15 In contrast, the Janeway lesion is painless, often ulcerates and is frequently productive of the causative organism.5, 11,12 Although Osler's nodes are most frequently seen in relationship to subacute bacterial endocarditis, they have been known to occur in cases of typhoid fever, gonorrhea, acute bacterial endocarditis, &dquo;marantic&dquo; thrombotic endocarditis, and rarely in lupus erythematosus. 1-3, 11, 16 Libman and Sacks recorded one such case where a nodule was observed in association with atypical verrucous endocarditis and a cutaneous eruption resembling lupus erythematoSUS.3 Keil3~ ~ has reported seeing Osler's nodes in two patients ~-ith systemic lupus.…”