Purplish red to necrotic raised lesion on the tips of the 3rd and 4th toes of the left leg - most likely to be Osler's nodes. Thought to occur due to inflammation subsequent to immune - complex deposition. Possible etiologies 1) Sub acute Bacterial Endocarditis 2) SLE 3) Marantic endocarditis / non bacterial thrombotic endocarditis ( possible etiologies - previous Rheumatic fever, hypercoagulable states, mucin producing adenocarcinomas, lupus, trauma ex. from catheters 4) Disseminated gonococcal infection
I really like your answer but u are really taking the case more serious than it should be simply it is gangrene in the fourth toe and Ischemic in the third one.
Nasty looking necrotic tissue on one, other seems mottled and not far behind. Gangrenous looking tissue probs on background of vascular disease / diabetes the rest of the foot looks surprising healthy!
I agree, that Osler's node will not be so..in your face. But for me both 3rd and 4th look gangrenous. Both 3rd and 4th seen to be the wet variety and the 4th seems to be more evolved and seems decidedly to just want the toe. The 3rd looks more ominous ( poorly demarcated and spreading ) and is the kinda that can pull a surprise on us, by rapidly involving the entire foot or even worse a septicemia. So knowing that it's a gangrene doesn't make me feel any better (-: Now even when I see an Osler's node....I am alerted to the possibility of a gangrene and sudden organ failures esp.kidney ( emboli from the vegetations ) . Bottomline - I agree to the comments above - 10 out of 10 times, this has to be a gangrene. I stand happily corrected (-:
