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Antonio Guerrero

@guerreroespejo

Aug 28

A 58-YO, toothache: swelling in the neck, sore throat, chills, chest pain; oral cavity indurated & woody, neck adenopathy; erythema spreading from his neck down over his anterior chest wall (A & B)
¼

#MedEd #IDtwitter #dermatology #MedTwitter
DOI: 10.1056/NEJMicm065036

LUDWING´S ANGINA is an infectious process involving the submental, sublingual, and submandibular spaces.

It can rapidly progress to hemodynamic instability and airway obstruction; in rare cases, it spreads into the mediastinum.
2/4

#Doctor #MedStudentTwitter #resident

Compromise of the airway can progress rapidly, with lethal consequences; therefore, immediate consideration should be given to surgical débridement of the infected areas and antimicrobial therapy.
¾

#medicine #MedicalStudents #microbiology #surgery

Read 4 tweets

Antonio Guerrero

@guerreroespejo

Aug 26

A 49-YO man “looking through branches in a tree.”: decreased vision in his L eye.

Fundus: linear and arcuate disturbances in the retina (A).

What´s in the vitreous?!! (B)
1/4

DOI: 10.1056/NEJMicm075735
#parasitology #OJO #Ophthalmology

A fly larva was initially observed in the macula and after 4 days of treatment with thiabendazole, a segmented fly larva in the vitreous (B).

OCULAR MYIASIS
2/4

#oftalmologia #parasites #eye

The patient elected to undergo vitrectomy.
Eight weeks after the vitrectomy, the lesions in the retina were attenuated and the visual acuity had improved to 20/40.
3/4

#MedEd #IDtwitter #MedTwitter

Read 4 tweets

Antonio Guerrero

@guerreroespejo

Aug 10

Clinical presentation and virological assessment of 181 confirmed human #monkeypox virus cases in #Spain
✔️92%, gay men, bisexual men, or other men who have sex with men (MSM) &
✔️8%, heterosexual men or women

(A) genital & pubic region pustules
👇
thelancet.com/journals/lance…

✔️Median age was 37 years (IQR 31–42).
✔️18% patients reported previous smallpox vaccination
2/

(B) Three semiconfluent pustular #monkeypox lesions with a depressed centre located on the left side of the tongue dorsum.

#MedEd

✔️40% were #HIV-positive, 11% had a CD4 cell count less than 500 cells per μL

✔️17% were diagnosed with a concurrent sexually transmitted infection

(C) Pearly acral #monkeypox vesicles embedded in the thick stratum corneum of the palmar skin, shotty on palpation
3/

#IDtwitter

Read 9 tweets

Antonio Guerrero

@guerreroespejo

Aug 9

A 40-year-old woman from Brazil, AIDS, CD4 91 cells/μL: headache, diffuse cerebral edema, coma, respiratory distress, tracheal secretion with nematode
(1), alveolar hemorrhage, periumbilical purpuric rash (2), & death

🔬brain: 3
1/

doi.org/10.1093/cid/ci…
#MedEd #IDtwitter

🔬tracheal secretion: Strongyloides stercoralis (1)

Skin biopsy: S. stercoralis larvae at the dermis and hypodermis.

DISSEMINATED STRONGYLOISIASIS WITH EXTENSIVE CUTANEOUS AND CEREBRAL INVOLVEMENT
2/5

#microbiology #MedStudentTwitter

Strongyloidiasis occurs worldwide, but predominates in tropical and subtropical areas.

People acquire the disease from penetration of larvae through the skin.
3/5

#MedicalStudents #MedTwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

Aug 8

Clinical features and novel presentations of human #monkeypox of 197 patients in a #London centre during the 2022 #outbreak

Median age: 38 years
All 197: men, &
196 identified as gay, bisexual, or other men who have sex with men
1/

bmj.com/content/378/bm…
#IDtwitter #MedTwitter

Concomitant infection:
- 35.9%: HIV
- 31.5%: a concomitant sexually transmitted infection.

All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%).
2/

#Doctor #MedStudentTwitter

86.3% participants reported systemic illness:
✔️ fever 61.9%),
✔️ lymphadenopathy (57.9%), and
✔️ myalgia (31.5%).
3/

#monkeypox #resident

Read 14 tweets

Antonio Guerrero

@guerreroespejo

Aug 7

👩‍🦳 in her 70s: on the L 🦶, initially appeared pruritic papules that evolved to fluid-filled blisters with tense and denuded bullae (Fig1).

Over the ensuing 6 weeks an expanding annular plaque with peripheral scale (Fig2).
¼

DOI:doi.org/10.1016/j.mayo…
#dermatology #mycology

🔬(KOH): hyphae
🧫: Trichophyton rubrum

BULLOUS TINEA PEDIS.

The patient responded well to terbinafine cream and dilute acetic acid soaks.
2/4

#microbiology #IDtwitter

Bullous tinea, seen in adults and children, and most often affecting the feet, presents with an erythematous scaly rash with serous fluid-filled bullae, as opposed to the pus-filled blisters of bullous impetigo.
3/4

#MedTwitter #Doctor #MedStudentTwitter #MedEd

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