Ravi Singh Profile picture
Apr 16, 2022 17 tweets 7 min read Read on X
1/17
“The skin truly can be a mirror of what’s going on inside the body “
During a #CPSbootcamp conversation we started discussing mosquito bites. How they can be a signal to internal disease ? Let's explore @deboracloureiro @KirtanPatolia @CPSolvers @seymss15
#MedTwitter
2/17
Mosquito saliva-induced type I hypersensitivity induces a strong itch sensation. This is a process of vasodilation + inflammation

First ➡️ immediate wheal and flare reaction develops within 15–30 min➡️ delayed pruritic induration arises within a day or 2 which resolves
3/17
Hypersensitivity to mosquito bites (HMB):

HMB or severe mosquito bite allergy (SMBA) is a cutaneous form of chronic active Epstein–Barr virus disease (CAEBV).

HMB belongs to a category of Epstein–Barr virus (EBV)-associated NK cell lymphoproliferative disorders (LPD). https://www.sciencedirect.com/science/article/pii/S132389302
4/17
HMB may progress to systemic diseases, such as hemophagocytic lymphohistiocytosis, chronic active EBV disease, and EBV-associated malignancies.
@KirtanPatolia
sciencedirect.com/science/articl…
5/17
A triad of elevated serum IgE, NK lymphocytosis, and detection of EBV DNA in peripheral blood is commonly observed, and identification of EBV-infected NK cells usually facilitates the diagnosis.
pubmed.ncbi.nlm.nih.gov/17169531/
6/17
HMB skin signs- include erythema, bullae, ulcers, necrosis, and scarring following the mosquito bite + high fever and general malaise
HMB patients= high EBV DNA load + NK cell lymphocytosis.
Lymphadenopathy, HSM, hepatic dysfunction, hematuria, and proteinuria are noted https://www.sciencedirect.com/science/article/pii/S132389302
7/17
Skeeter syndrome:
Allergic reaction to mosquito bites, which can cause red, swollen lesions. They usally occur in children or immunocompromised adults.

The reaction is characterized by the signs of inflammation: swelling, heat, redness, and itching/pain. +/- fever http://bitestreatment.com/mosquito-bites/skeeter-syndrome-sy
8/17
Skeeter syndrome is caused by allergenic polypeptides that spit off with mosquito saliva during siphoning human blood
Skeeter syndrome is often misdiagnosed as a bacterial skin infection called cellulitis
9/ 17
The reaction can evolve into:
-Facial edema
-eyelid edema
-limbs can turn red and swollen.
-can progresss to bruising and blistering, fever, vomiting or difficulty breathing
10/17
There also exists an exaggerated cutaneous response to bites in patients with hematological malignancies, especially CLL/CML

Skin lesions usually appear months to years after the dx of leukemia and are unrelated to lab findings, disease course, or therapy
11/ 17
As far back as 1911, this association was documented in the article Skin changes in the leukemias and altered conditions by J. Cutan in the journal- Disease.
sciencedirect.com/science/articl… https://www.sciencedirect.com/science/article/pii/S000649712
12/17
The reaction to mosquito bites results in severe itchy papulovesicular lesions with induration edema, erythema, and intense pruritus; the reaction reaches its peak within 12-24 hours. Bullae up to 10 cm in diameter can develop in severe cases.
13/17
There have been many case reports of patients having these severe reactions and whilst seeking medical care they are found to have a diagnosis of CLL.
sciencerepository.org/insect-bite-li…
14/17
- 21 y/o pt with an exaggerated hypersensitivity reaction to a mosquito bite noted to have splenomegaly. The blood tests that were performed were compatible with chronic myeloid leukemia (CML). Here the mosquito bite heralded the diagnosis of CML
hindawi.com/journals/criem…
15/17
Lastly
An 11-year-old presents with swelling of his chin after being bitten by mosquitos. Maxillofacial computed tomography showed cellulitis of the chin without abscess. Lab workup was notable for a peripheral eosinophilia (1220/μL). https://www.jaci-inpractice.org/article/S2213-2198(17)30162-
16/17
He was found to have : Wells syndrome, or eosinophilic cellulitis.- first described by Wells in 1971
Involves edema + induration & can appear very similar to bacterial cellulitis. It can be associated with red plaques and blisters/bullae.
jaci-inpractice.org/article/S2213-…
17/17

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Ravi Singh

Ravi Singh Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @rav7ks

May 6, 2022
1/8
You start SQ insulin on a patient and they develop peripheral edema ?
What is the mechanism of "Insulin edema" ?
#MedTwitter #MedStudentTwitter
2/8
This condition was initially reported by Aaron Leifer, M.D. in 1928 in a 41-year-old male patient started on an insulin regimen which was published in JAMA.

Leifer A. A CASE OF INSULIN EDEMA. JAMA. 1928;90(8):610–611. doi:10.1001/jama.1928.92690350001012
3/8
The severity of edema is usually mild, involving the limbs, sparing the torso and face.
Resolution is usually seen after one to two weeks of conservative treatment with fluid and salt restriction and may or may not involve the use of diuretics
grepmed.com/images/6334/dr…
Read 8 tweets
May 20, 2021
1/ 10 The most recognized form of Non-Cardiogenic pulmonary edema(NCPE) is ARDS, however the scope of NCPE is much broader with many causes. One particular cause of NCPE we encountered was due to opoid use which is explored in this #medtweetorial
#MedTwitter #MedStudentTwitter
2/10 The onset of noncardiogenic pulmonary edema after opioid overdose was first described by Osler
during an autopsy in 1880

Osler W. Oedema of the left lung — morphia poisoning: Montreal General Hospital Reports Clinical and Pathological. Montreal: Dawson Bros., 1880:291.
3/10 Its presentation and clinical course was not appreciated until the 1950s-60s.
-mechanism is known to involve ⬆️ alveolar capillary permeability
-Opioid-related NCPE presents as :
dyspnea +/- pink, frothy pulmonary secretions
+ hypoxia
Other criteria is detailed below:
Read 10 tweets
Feb 23, 2021
1/ Is bandemia with a normal WBC count concerning for a lethal infection?
It's a very interesting concept which I've faced and will explore below :
#MedTwitter #MedStudentTwitter #FOAMed
2/“Left shift” means that a particular population of cells is “shifted” towards more immature precursors
Josef Arneth (1873-1955) described this left-shift term.

% neutrophils is commonly reported as a "left shift" in the Diff which is incorrect
jamanetwork.com/journals/jama/…
3/Mechanical hematologic counters were used early on last century which perpetuated the term" left shift" with the manual counting of immature neutrophils which were towards the left side of the mature cells on the counter.
Read 11 tweets
Dec 17, 2020
1/ "Don't forget to correct that phosphate so that the it can help the patient recover from acute respiratory failure !" This concept triggered a lot of questions on rounds.
It's worth taking a quick look at this association !
#medtwitter #MedStudentTwitter #FOAMed #phosphate
2/⬇️Phosphate leads to ⬇️red cell 2,3-DPG and a reduction in ATP.
⬇️Phosphate diverts glucose -> 1,3-DPG into the Rapoport-Leubering pathway away from ATP generation towards producing 2,3-DPG so that the oxygen affinity of RBC's does not increase and the tissues receive O2.
3/⬇️Phosphate does also impact RBC survivability with a
⬆️hemolysis, ⬇️in RBC deformability, ⬇️ capillary transit and ⬇️GSH.
Read 11 tweets
Sep 25, 2020
1/Why does the Hg/Hct drop in the first two days during hospitalization ?
We'll explore this issue in this short #medtweetorial
#medtwitter #FOAMed #MedStudentTwitter
2/Interestingly , anemia of hospitalization is commonly thought to be due to
- phlebotomy
- IVF
- invasive procedures/ bleeding etc

However, prolonged bed rest can contribute to a drop in your pts blood count !
Another reason to get our patient's out of bed if possible !
3/Until the mid-20th century, bedrest was considered a benefit that helped people heal. Hippocrates had already noted the risk of loss of muscle, bone and tooth(Chadwick and Mann, 1950)
Today, there is recognition of bedrest’s negative effects on body and the blood volume.
Read 14 tweets
Sep 8, 2020
1/ LR has been making the rounds on #MedTwitter recently so I decided to put all of the important points versus NS into an infographic with additional points
@MohitHarshMD
#MedTwitter #MedStudentTwitter #Medtweetorials Image
2/ NS can cause coagulopathy
- NS dilutes clotting factors ➡️ impairing coagulation and hemostasis.
-NS can cause a functional impairment of thrombin and fibrinogen
- ⬆️ disruption of existing clots.
- acidic milieu can also ⬇️ clot formation/stability

pubmed.ncbi.nlm.nih.gov/17414340/
3/ In Traumatology:
NS can lead to:
-compartment syndrome
-dilutional coagulopathy
-hyperchloremic metabolic acidosis
-immune dysfunction

pubmed.ncbi.nlm.nih.gov/16832250/
Read 12 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(