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 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 46-YO ♂️: oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health.

Needle aspiration from submandibular lymph node: intra- and extracellular yeasts
1/4

DOI:
doi.org/10.4269/ajtmh.…
#dermpath #mycology

The histopathology of oral lesion showed features of HISTOPLASMOSIS confirmed later from culture of Histoplasma capsulatum on culture
2/4

#IDtwitter #microbiology #MedTwitter

In immunocompetent hosts, when chronic disseminated histoplasmosis occurs from pulmonary infection, oral ulcers, nodules, and vegetative plaques are common and dissemination to liver, spleen, bone marrow, and other organs is frequent.
3/4

#Doctor #MedStudentTwitter #resident

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

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

Dermpath_doc_trish

@PIorfino

This little lesion was a cute surprise. It came in from the finger (radial nail fold) of a 46 yo male, clinically described as either a wart or callus.

Let’s take a little look 👀see🫣shall we?#dermpath #trishtorial #pathtwitter@

Things you can notice at low power:
🔺acral skin with nail☑️,
🔺no epidermal collarette around area of lesion (which appears dermal)☑️,
🔺something looks bluish☑️

So let’s start figuring this out, yes 🙌? Is this a:

Read 9 tweets

Tristan Rutland MBBS FRCPA IFCAP

@TristanRutland7

Adult

#BSTpath #Dermpath #Pathresidents #Pathtwitter

Based on the above images, what is your first impression?

* Dermatofibrosarcoma protuberans
^Pleomorphic dermal sarcoma

S100 and SOX10

Read 23 tweets

Gerônimo Jr.

@GeronimoJrLapac

Skin.
Two images to think about in this diagnosis.
What tips can we list in these two images?
What did I sign?
Next step?

#dermpath #pathology

1- In these images, I want to draw attention to two tips. First, that there is a combination of patterns (Lichenoid + psoriasiform). A combination of different reaction patterns should always make you think of syphilis.

2- Another tip is what I drew: Rete ridges. Dr Elston's famous quote for them is sexy ridges. Very characteristic of syphilis.
Next step: Thinking about syphilis, look for plasma cells.

Read 4 tweets

Dr. LoB

@allobe86

Paciente de 70 años,natural de Pakistan.Presenta la siguientes lesiones a nivel cervical.

¿En qué entidad pensarías?
#dermatology #dermatología #2MIR23 #2MIR24 #ENARM2023 #dermtwitter #dermpath #MedTwitter #medicina

Elige la respuesta correcta:

En este caso,para llegar al diagnóstico, ¿cuál de las siguientes opciones es la más correcta?

Read 7 tweets

Arjun Ramaiya

@ArjunRamaiya1

Classic and common dual pathology. 70 Male curetted “Seborrhoeic keratosis” …..which its not 🤣🤣🤣
#dermpath #dermtwitter #pathtwitter #dermatology #dermatologist #pathologist #dermatopathologia #dermatopathology

Morphology: basal cell carcinoma with an unusually diffuse and dense infiltrate of monotonous small inactive lymphocytes.

Immunohistochemistry:

Read 4 tweets

Jisun Cha MD FAAD

@sunpungi

Another case to discuss, Cylindroma on 91yo female abdomen. it’s multiple in dermatomal distribution with extreme pain. There is this nerve entrapment at the base of the section. Histology seems benign but somewhat infiltrated nodules at the base. Q below #dermpath #derm

It is challenging to treat, and also a concern if this is malignant based on clinical behavior. I am suggesting to excise the prominent nodules with local radiation for the rest of small nodules in the region. Any other thoughts ?

This patient has no history of syndromic features, but she had to remove 2 ft intestines in the past(I couldn’t get the detail but assume obstruction or diverticulitis).

Read 5 tweets

Christine J. Ko, MD

@ChristineJKoMD

@yalederm

Sept challenge! recently taught @yalederm, trying to channel thinking, fast and slow:thru 9/30, 1 #dermpath/day, 10 AM EST (please retweet!) - can you mentally match each posted WSI (not all rep'ed here) with these clinical? in other words, what'd be the #histopath? @kikofordocs

@JeffGehlhausen

3rd photo courtesy @JeffGehlhausen , 4th courtesy Dr. Sarah Kim @yalederm, rest courtesy @yalederm

@forthejon

Around September 30th, there will be "review" and an index of these cases on KiKo (credit to @forthejon for a great platform!) - please share with anyone interested in a case/day @JMGardnerMD @RoxanaDaneshjou @michi_shinohara @MishaRosenbach @DrStevenTChen @sunpungi

Read 6 tweets

Jisun Cha MD FAAD

@sunpungi

Monkeypox #monkeypox #pathology #dermatology #dermpath

Dome shaped papule with central ulcer and massive necrosis, prominent cytoplasmic ballooning degeneration of epithelial cells noted in peripheral edges of the papule.

The ballooning degeneration mainly occurred in the lower part of the epidermis, underlying dermis is necrotic with vascular occlusion and dense inflammation.

Read 5 tweets

Steven Chen 陳持威, MD, MPH, MHPEd

@DrStevenTChen

It's overdue. Time for a #dermtwitter #tweetorial on...

SEZARY SYNDROME!

We're going to focus on presentation and work up!

#sezary #ctcl #medtwitter #onctwitter #meded #FOAMEd
1/

Just a few years ago, Sezary Syndrome (SS) was thought to be the leukemic variant of Mycosis Fungoides (MF). We basically thought people had MF, it would keep getting worse, and then it would turn into SS.

Check out my old #tweetorial on MF here👇
2/

https://twitter.com/DrStevenTChen/status/1147926420468846592?s=20&t=97wFnOJX-F61l5EYZ1IoOQ

But patients often present with either the classic SS exam (red all over, super itchy), or with MF. Some patients would progress from MF--> SS, but it's the minority. So it became clear these are two different processes.

For that reason, we've changed how we think about it...
3/

Read 17 tweets

Rami Al-Rohil

@Rami_AlRohil

Areas of hyperpigmentation on bilateral cheeks, what is your diagnosis? #dermpath #pathology #dermatology

Final diagnosis: Ochronosis 🔬 Banana/crescentic shaped, ochre-colored fibers that can be free in the dermis or within macrophages #dermpath #pathology #dermatology

Can occur in
(1) Alkaptonuria-Dark blue pigmentation of head/neck, sclera, ears & palmoplantar
(2) Hydroquinone induced (skin bleaching agent)-Usually face/neck
(3) Anti-malarial drug-induced–Subungual, pretibial & facial pigmentation #dermpath #pathology #dermatology

Read 3 tweets

Emmanuel Maicas

@DermwizGuy

Due to the current outbreak of monkeypox in Western countries, I thought it would be good to review the clinical and pathology of this rare disease. More below.
#monkeypox #pathology #dermpath #dermatology

Previously, monkeypox outbreaks were zoonotic from monkeys or rodents. The current outbreak is human-to-human. Currently, most cases are homosexual males with genital skin lesions.

Incubation period of 1-2 wks, followed by fever, headache, backache, and vomiting. Skin lesions start as macules, then vesicles, papules, pustules, and crusts.

Source of photo: ncbi.nlm.nih.gov/pmc/articles/P…

Read 6 tweets

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