The journey to the diagnosis of Sweet syndrome and its differentials is too sweet 🍬🍩🍫

Let's explore the sweetness.

@rabihmgeha @DxRxEdu @Sharminzi @DrCindyCooper @jackpenner @sargsyanz @rav7ks @RebeccaEBerger @RosenelliEM @CPSolvers @MithuRheum #MedTwitter #rheumatology
#1 Malignancies & Sweet syndrome

- AML (common)
- MDS (common)
- CML
- MM
- Hodgkin's lymphoma
- NHL
- Mycoses fungoides
- Cutaneous T-cell lymphoma
- Hairy cell leukemia
- Solid tumors

#oncology #hematology #MedTwitter
#2 Autoimmune disorders & Sweet syndrome

- IBD (common)
- Behcet (common)
- SLE (common)
- RA (common)
- Relapsing polychondritis
- Sarcoidosis
- Sjogren's
- Familial Mediterranean fever
- Undifferentiated connective tissue disease
- Erythema nodosum

#rheumatology #MedTwitter
#3 Medications & Sweet syndrome

- G-CSF
- GM-CSF
- Trimethoprim-sulfamethoxazole
- Minocycline
- All trans-retinoic acid
#4 Infections & Sweet syndrome

- Streptococcal pneumonia (common)
- Salmonella
- Francisella
- Yersinia
- Coccidioidomycosis
- Sporotrichosis
- HIV
- CMV

#infectiousdiseases
#5 Sweet syndrome differentials

#1 [Pyoderma gangrenosum]
- IBD
- Behcet
- Leukemias
- MM (IgA gammopathy)
- Psoriatic arthritis
- Primary biliary cirrhosis
#6 Sweet syndrome differentials

#2 Miscellaneous
- Leukemia cutis
- Bowel associated arthritis dermatitis syndrome
- Neutrophilic rheumatoid dermatitis
- Leukocytoclastic vasculitis
- Acute hemorrhagic edema of childhood
- Halogenoderma
- Rosacea fulminans
- Ecthyma gangrenosum
#7 Rare differential of Sweet syndrome

- PAPA syndrome
- Atypical mycobacterial infections
- Anthrax
- Verrucous carcinoma

Thanks for reading. Any suggestions appreciated.

#MedTwitter @ASanchez_PS @nsrosenberg @MatthewHoMD

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More from @KirtanPatolia

Apr 13
Differential diagnoses of ⛈️Thunderclap headache⚡ are indeed thunderous.

Here is a brief 🧵.

@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers

#MedTwitter #NeuroTwitter #Neurology
#1 Subarachnoid hemorrhage

Aneurysmal SAH
Cortical SAH (due to RCVS)

- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF

Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus

#MedTwitter #Neurology

nejm.org/doi/10.1056/NE…
#2 RCVS

-Multifocal multivessel vasoconstriction (string of beads)
-Recurrent episodes (triggers- bathing, Valsalva, bending, urinating, strong emotions)

Risk factors: Postpartum state, SSRIs, Calcineurin inhibitors, vasoactive drugs, sympathetic overactive states

#MedTwitter
Read 11 tweets
Dec 20, 2021
Differential diagnosis of RA-like arthritis based on the pattern of joint involvement is fascinating

Here is a 🧵 exploring this journey

#medtwitter #RheumTwitter @CPSolvers @rabihmgeha @DrCindyCooper @DxRxEdu @Sharminzi @sargsyanz @rav7ks @RosenelliEM @AnnKumfer @jackpenner
Various patterns of hand joint involvement

- PIP +DIP +1st CMC = OA
- MCP +PIP +Wrist = RA
- 2nd & 3rd MCP = Hemochromatosis
- Wrist +2nd MCP + 2nd PIP + all DIP= PsA
- Dactylitis/Sausage digits = PsA, Sickle cell anemia, Polyarticular gout, Sarcoidosis

#medtwitter @MithuRheum
Infections causing RA-like pattern

- Parvovirus B19
- HTLV-1
- Rubella
- HBV, VZV, Mumps (Large joints more common)
- HIV
- Arboviruses: Chikungunya, Dengue
- Poncet's disease/ Tuberculous Rheumatism

#medtwitter
Read 9 tweets
Oct 28, 2021
Not many entities in Medicine are as intricate as Paraproteinemias

As we celebrate National Internal medicine day today, here is a 🧵exploring its various associations and complications

#MedTwitter #hematology @AnnKumfer @RebeccaEBerger @Sharminzi @rabihmgeha @DxRxEdu @rav7ks
Entities that can feature a monoclonal protein/M component:

-MM
-WM
-MGUS
-MGCS
-MGRS
-Splenic Marginal Zone Lymphoma (HCV)
-CLL & MBL
-Heavy Chain disease (Gamma, Alpha & Mu)

There are various others indirectly associated with the M component. More to follow
Skin manifestations

-Scleromyxedema
-NXG
-Neutrophilic dermatosis
-Pyoderma gangrenosum
-Cutaneous macroglobulinosis
-POEMS: hypertrichosis, hyperpigmentation, hemangiomata, clubbing
-Clarkson/Systemic capillary leak syndrome
-Erythema elevatum et diutinium

#dermtwitter
Read 9 tweets
Oct 25, 2021
Guillain barre / GBS has an interesting differential diagnosis that has crucial management implications

Here is a thread based on what I have learned from my dear residents, attendings & journals

#MedTwitter #NeuroTwitter @rabihmgeha @DxRxEdu @AaronLBerkowitz @rav7ks
#1 GBS

- Infxs (C. jejuni, Mycoplasma, EBV, CMV, Zika,Influenza, HIV)
- Ascending weakness
- Cranial nerve involvement (CN 7)
- Usually no bowel/bladder disturbances
- Cyto-albuminologic dissociation and areflexia (may not manifest very early on)
- Rx - IVIG & Plasmapheresis
#2 GBS Variants and antibodies:

- AIDP
- Facial diplegia and paresthesia
- AMAN & AMSAN (GM1, GD1a)
- Phayngeal-Cervical-Brachial weakness (GT1a/GQ1b)
- Miller Fisher (GQ1b) (Areflexia + Ataxia + Opthalmoplegia)
- Bickerstaff encepahlitis (GQ1b)
- Pure Autonomic variant
Read 11 tweets
Oct 19, 2021
Adult-onset Still's disease/sJIA is beyond fascinating. The myriad of symptoms it can present with overlaps with many other disorders

Here is a thread exploring its spectrum

Any suggestions appreciated

#MedTwitter @CPSolvers @rabihmgeha @DxRxEdu @sargsyanz @rav7ks
Still's disease/sJIA classic symptoms
- Fever (Quotidian)
- Sore throat
- Synovitis/Arthralgia
- Hepatosplenomegaly
- Rash (Evanescent Salmon colored)
- Lymphadenopathy
- Anemia + Leukocytosis + Thrombocytosis + Hyperferritenemia + elevated ESR
- Rx (IL-1 inhibition)
Still's mimic #1 - Acute Rheumatic Fever

- Fever
- Sore throat (follows GAS pharyngitis)
- Arthralgia/Arthritis
- Rash (Erythema Marginatum)
- Elevated ESR
- Chorea
- Myopericarditis
Read 10 tweets
Apr 26, 2021
Inspired by recent posts from @AaronGoodman33 , here is my attempt to review briefly the interplay between Hematology and Autoimmune phenomena.

It's magic when that fusion occurs.

Any comments & suggestions appreciated.

#MedTwitter @rabihmgeha @DxRxEdu @CPSolvers
CLL & Autoantibodies:

1.) WAIHA (IgG), CAD (IgM), PCH

2.) PRCA, Autoimmune Neutropenia

3.) C1-NH (acquired angioedema)

4.) GM-CSF (Pulmonary alveolar Proteinosis)

5.) Factor VIII, vWD, V (Coagulopathy)

6.) ADAMTS13 (TTP)

7.) CFH & CFI (aHUS)

contd...

#MedTwitter
8.) CaSR (Hypocalcemia or Hypercalcemia)

9.) Desmoglein, BPAG1 Envoplakin, Periplakin (Paraneoplastic Pemphigus)

10.) ITP, Evans syndrome

11.) Insulin or Insulin receptor (Hypoglycemia or Hyperglycemia)

12.) C3 Nephritic factor (MPGN1)

#MedTwitter #hematology
Read 8 tweets

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