https://twitter.com/MateosVillena/status/1664992755188154371?t=orJYGHgr6XBIw0dUozJMUA&s=19

Edvil Mateos

@MateosVillena

What are we looking at?
Is this a tubular object?

-Case H&E 1108
Male 65 years
Warty lesion on face
Diagnosis:
Squamous carcinoma

(Via Virtual Pathology Slide Library)
#dermatology #Microscopy #glochid

Source: virtualpathology.leeds.ac.uk/slides/library…

A section of a tube is an ellipsoid, which can be a circle when the section is perpendicular to the tube.

Read 4 tweets

Edvil Mateos

@MateosVillena

Spot the transparent thorns
Clue: some look like horns

- Case H&E 1080
Female 45 years
Warty lesion on hand
Diagnosis:
Squamous papilloma

(Via Virtual Pathology Slide Library)
#Skin #Wart #HPV #Glochids #Dermatology

Link: virtualpathology.leeds.ac.uk/slides/library…

Here there are some horns, tip of thorns

Read 5 tweets

Edvil Mateos

@MateosVillena

Mechanical irritant dermatitis
What is inside the itching?
#dermatology

The outer skin of the little lump is decapitated with a needle, revealing a small thorn. Then the rest of the spines are "combed" with the needle, scratching the skin.

At some point, it will start to bleed. Use a nail clipper or similar to remove as many raised spines (or bits of them) as you can.

Read 4 tweets

Arjun Ramaiya

@ArjunRamaiya1

FINALLY clinician’s have figured that the PSEUDOSCIENTIFIC term “squamoproliferative lesion” means nothing more than a proliferating squamous lesion 🤣
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #dermatologist #histopathology #dermatopathology

Squamoproliferative lesion was invented by some hotshot pathologist pretending its a diagnostic entity, but it actually means nothing more than an unspecified and unqualified proliferating squamous “lesion”.

#dermpath #dermtwitter #pathtwitter #dermatology #dermatopathology

Viral warts, seborrhoeic keratosis, actinic keratosis, keratoacanthomas, in situ and invasive squamous carcinomas are ALL either benign, atypical or malignant “squamoproliferative lesions”
🤣🤣🤣
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #histopathology

Read 4 tweets

Dermpath_doc_trish

@PIorfino

Finally a quiet moment😓.
This is an interesting case that came through this week:

76 F Rt Forehead.
SCC vs NUB #skin #dermpath #dermatology #dermatopathology #pathology #pathtwitter
low power 1st:

Next is higher power at 100x

And now 200x

Read 6 tweets

Arjun Ramaiya

@ArjunRamaiya1

50+ Female, painful “end” nodule middle finger after trauma ?Neuroma

A rare Pacinian Corpuscle Neuroma 🤩

#dermpath #dermtwitter #pathtwitter #pathresident #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology

@DiegoMoralesN

And tagging my icons to say “thank you” for your valued contributions and teaching 🙏
@DiegoMoralesN @melanopath @mccalmo @et565 @JacobSmalberger @alegru18 @CarlosMonteag20 @atman_ci @PIorfino @HENRYY_MD @kis_lorand @AlomariDermpath @CArnold_Coach @DKalodimou @ChristineJKoMD

A short commentary of some interesting facts.

Read 3 tweets

Antonio Guerrero

@guerreroespejo

An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB
Mycobacterial🧫:➖
1/19

#IDtwitter #dermatology

A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).
2/19

DOI: doi.org/10.1128/jcm.00…
#dermpath #microbiology

Molecular identification: 100% identity to multiple Mycobacterium leprae

BORDERLINE LEPROMATOUS LEPROSY WITH REVERSAL REACTION
3/19

#MedTwitter #MolBiol

Read 19 tweets

Dermpath_doc_trish

@PIorfino

Feeling lucky 🎰?
🍑vs 🍓.
These 2 lesions are similar but not the same. Let’s take a closer 👀 look…
#skin #dermpath #dermatology #dermatopathology #pathology #dermresident #dermboards #dermboardsstudying #pathologist #surgicalpathology #surgpath #pathtwitter #pathresident

Let’s look closer at peach 🍑

Now closer at strawberry 🍓

Read 8 tweets

Dermpath_doc_trish

@PIorfino

A pathologist’s first words:

“red is dead, blue is bad.”

This picture of a slide encapsulates both in one image.

#skin #dermpath #dermatology #dermatopathology #pathology #pathologist #surgicalpathology #surgpath #pathtwitter #pathresident #trishtorial

Only 53…leg. Didn’t suspect it. Only hx of prior nevi removed.
I suppose it’s obvious where the diagnosis is headed…

I only did 3 stains, probably could have used just 1, but with the lack of history I guess it felt right to super-prove it .

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 26-YO♂️ no #sexual contacts other than with his male partner: 6-day of fever, malaise, a swollen parotid gland, & ulcerative lesion on the ipsilateral lower lip.

Mild lymphopenia
⬆️GGT & CRP

1/6
doi.org/10.1016/S0140-…
#IDtwitter #dermatology #EarNoseThroat

PCRs on the throat & ulcer swabs:➕for human #monkeypox (hMPX)
Genomic sequencing: clade IIb variant clustering within the current international mpox virus outbreak

PAROTIDITIS CAUSED BY hMPX virus

2/6
#sexually #maxillofacial #microbiology

7 days after initial presentation, his clinical condition had improved together with a decrease in the parotid swelling and the size of the ulcer.
3/6

#MedTwitter #Doctor #MedStudentTwitter

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.
1/9

#rheumatology #internalmedicine #dermatology

Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
2/9

doi.org/10.1093/cid/ci…
#microbiology #rheumatologist

Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.

RAT BITE FEVER (RBF) WITH SEPTIC ARTHRITIS DUE STREPTOBACILLUS MONILIFORMIS
3/9

#bacteriology #IDtwitter #microbiología

Read 9 tweets

Antonio Guerrero

@guerreroespejo

@ContinuumAEP

13 años ♂️: lesiones verrugosas en mucosa oral de 2 años de evolución, con progresivo aumento en tamaño y número.
1/7

🖊️Alonso P, Vázquez A, Santos JL.
continuum.aeped.es/screens/play/1…
@ContinuumAEP @aepediatria
#pediatria #dentista #AtencionPrimaria

@ContinuumAEP

@ContinuumAEP @aepediatria HIPERPLASIA EPITELIAS FOCAL o ENFERMEDAD DE HECK:
📌infección viral rara de la mucosa oral
📌causada por el virus del papiloma humano, especialmente los subtipos 13 o 32.
2/7

#infecciosas #microbiología #MIR

@ContinuumAEP

@ContinuumAEP @aepediatria ✔️Es una proliferación epitelial benigna, ✔️asintomática,
✔️ múltiples pápulas de 3 a 10 mm con color de mucosa oral normal.

La frecuencia de esta enfermedad varía ampliamente de una región geográfica y grupo étnico a otro.
3/7

#healthcare #MedicinaInterna

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 17-YO♀️, unprotected #sexual intercourse with multiple male partners: a 1-month history of pruritic genital lesions, multiple smooth, grayish-white papules & plaques were noted on the vulva & upper inner thighs.
1/5

DOI: 10.1056/NEJMicm2207538
#gynecology #womenshealth

A Treponema pallidum particle agglutination assay:➕
Rapid plasma reagin titer: ➕1:16.

CONDYLOMA LATA OF SECONDARY SYPHILIS
2/5

#microbiology #gynecologist #primarycare

✔️Testing for other sexually transmitted infections, including HIV infection: ➖

✔️Counseling on the importance of condom use

✔️IM penicillin G benzathine
At the 1-month follow-up visit, the lesions had resolved, and the RPR was 1:8.
3/5

#dermtwitter #IDtwitter #MedTwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 50-YO♂️of North India, visited bat caves & a bird sanctuary in Thailand: multiple plaques & nodules on his face, neck, arms & trunk with hoarseness, fever, weight loss for months
Laryngoscopy: nodules over the tonsils & posterior pharyngeal wall
1/4

#medicine #dermatology

Skin & laryngeal 🔬: histiocytes with intracellular & extracellular PAS+ yeast cells
Skin biopsy🧫: tuberculate macroconidia confirmed as H. capsulatum var. capsulatum
Ab against Histoplasma by ID:➕

DISSEMINATED HISTOPLASMOSIS
2/4

doi.org/10.3109/136937…
#mycology #IDtwitter

Disseminated histoplasmosis involving skin & larynx in an apparently immunocompetent individual

The infection appeared to be imported from Thailand.

The patient responded very well to intravenous amphotericin B followed by itraconazole.
3/4

#microbiology #MedTwitter #Doctor

Read 4 tweets

Antonio Guerrero

@guerreroespejo

A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?
1/7

#IDTwitter #microbiology

🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.

PROGRESSIVE DISSEMINATED HISTOPLASMOSIS
2/7

doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine

Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate
3/7

#MedTwitter #Doctor

Read 7 tweets

Antonio Guerrero

@guerreroespejo

@olaya_sm

39 años ♂️: hiperqueratosis subungueal y coloración amarillo-verdosa de la lámina ungueal del 5º dedo de pie dcho. de 2 años de evolución.

1/ 7

✍️B. Monteagudo, O. Figueroa, @olaya_sm, S. Méndez
DOI: 10.1016/j.ad.2018.04.013
#dermatología #microbiología

@olaya_sm

@olaya_sm Con 🔍: Hiperqueratosis subungueal (&), borde distal irregular, zonas parduzcas de aspecto hemorrágico (&) y patrón multicolor de lámina ungueal con áreas verdes ($) y azul-negruzcas (*), y otras longitudinales amarillentas (→)

CLORONIQUIA
2/7

#dermatology

@olaya_sm

@olaya_sm 🧫 uña: Pseudomonas aeruginosa y hongo filamentoso (imposible identificar por sobrecrecimiento bacteriano).

UÑA VERDE CAUSADA POR ONICOMICOSIS COINFECTADA POR PSEUDOMONAS AERUGINOSA

Con ciprofloxacino oral y terbinafina, tres meses: resolución.
3/7

#AtencionPrimaria #micología

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles
1/7

#IDtwitter #primarycare

PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3

#MPOX (MONKEYPOX)
2/7

#healthcare #internalmedicine #microbiology
doi.org/10.1016/j.idcr…

Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.
3/7

#MedTwitter #MedStudentTwitter #dermtwitter

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes
1/5

#IDtwitter #primarycare #healthcare

HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus

MPOX (MONKEYPOX)
2/5

#internalmedicine #microbiology doi.org/10.1016/j.idcr…

Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas
3/5

#MedTwitter #MedStudentTwitter #dermtwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.
1/6

#internalmedicine #IDtwitter

Skin biopsy🔬: bilateral invasive squamous cell carcinomas.

BILATERAL INVASIVE SQUAMOUS CELL CARCINOMAS (MARJOLIN ULCERS)
2/6

#dermatology #dermpath
doi.org/10.1093/cid/ci…

The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.
3/6

#Doctor #healthcare #MedStudentTwitter

Read 6 tweets

Provectus Biopharmaceuticals, Inc.

@ProvectusBio

1/ A $PVCT THREAD: (3) Potential 2023 read outs of preclinical data from sponsored research programs (#SRAs) in different diseases. #research. #oncology #hematology #dermatology #InfectiousDiseases #ophthalmology #WoundHealing #TissueRegeneration. #rosebengal #rosebengalsodium.

https://twitter.com/ProvectusBio/status/1612438924206702594

2/ $PVCT 2023 Stockholder Letter (released January 9th).

https://twitter.com/ProvectusBio/status/1612438924206702594

. #rosebengal #rosebengalsodium.

3/ In 2023, $PVCT expects research collaborators at different academic medical institutions to read out data from their preclinical research work under newly established and existing #SRAs. #research. #rosebengal #rosebengalsodium.

Read 60 tweets

Provectus Biopharmaceuticals, Inc.

@ProvectusBio