#idboardreview 60 F RA on chronic steroids presents w/ progressive R wrist pain/swelling s/p I&D, progressively worse erythema spreading up the arm. Tendon micro+small gray colonies & thin, septate hyphae branching at acute angles. Diagnosis? #medEd #idmeded #idtwitter ImageImage
#scedosporium apiospermum is the anamorph or asexual form of #Pseudallescheria boydii. Usual sites of infection include CNS, eyes, lungs, sinuses, bones, joints, and soft tissues jcm.asm.org/content/43/2/9…
#scedosporium Fast growing, greyish-white colonies suede-like to downy w/ greyish-black reverse. Numerous single-celled, pale-brown, broadly clavate to ovoid conidia, 4-9 x 6-10 µm, rounded above w/ truncate bases are observed mycology.adelaide.edu.au/descriptions/h…
CNS or sino-pulmonary infection after 'near-drowning' #scedosporium nejm.org/doi/10.1056/NE…
#scedosporium typically occurs in immunocompromised individuals or post trauma
-CNS infection in immunocompetent post near-drowing
-Found in soil, fresh water especially stagnant or polluted water
#scedosporium apiospermum is the most commont sp infecting humans. Identification typically by DNA sequencing. Dx: culture recovering from infected site. Because airway may be colonized, sputum cultures may not reflect infection
#scedosporium voriconazole likely the most effective agent
#scedosporium #prolificans disseminated (severely immunosuppressed)), B&J infection. May cause onychomycosis & infections of eye/wounds. Localized infections in immunocompetent post trauma. Organism in soil and can colonize respiratory tract. No effective tx. Consider vori+ampho

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#idboardreview 70 F presents w/ fever, myalgia, dyspnea: CXR RLL pneumonia/effusion, resp fail leading to death. Her dog recently died who was seen with rabbit caracass. Diagnosis? #medEd #idmedEd #idtwitter
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#idboardreview 40 F multiple sclerosis on natalizumab presents w/ coordination difficulties and cognitive impairment. MRI non-enhancing subcortical white matter frontal lesions hyperintense on T2 & hypointense on T1. Diagnosis? #medEd #idmedEd #IDtwitter
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#PML Ref P&P ID Mandell
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#idboardreview 50 F recent dental infection presents 4d of fever, R headache, L weakness. MRI ring enhancing lesion & aspirate w/ GPC ‘balls of yarn’ 🧶 diagnosis? #medEd #idmedEd #IDtwitter
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MRI demonstrate a ring enhancing lesion in R frontal lobe with vivid central restricted diffusion. The enhancing component has a complete low T2 rim #brain abscess Ref: radiopaedia.org/cases/cerebral…
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#idboardreview 50 M unstable housing presents w/ fever, hip & knee pain and swelling. Knee aspirate shows gram negative rod in chains w/ lateral bulbar swelling. Diagnosis? #medEd #idmedEd #IDTwitter Image
#Streptobacillus moniliformis, the etiologic agent of rat-bite fever
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