A👨, HIV + (CD4 = 25 cells/mm3): rash on arms, hands, chest, & buttocks compatible with #monkeypox
Ocular: redness, pain, itching, swelling, discharge, photosensitivity, & vision changes

Unilateral conjunctivitis, ulcer, & keratitis (fig.)
1/8

#ophthalmology #IDtwitter
A PCR swab of the conjunctival lesion:➕for Orthopoxvirus

OCULAR #MONKEYPOX
2/8

DOI: dx.doi.org/10.15585/mmwr.…
#eye #ojo #oftalmologia
Patients with #monkeypox can experience serious ocular complications:
5 consecutive patients with ocular monkeypox, have experienced delays in treatment, prolonged illness, hospitalization, & vision impairment.
3/8

DOI: dx.doi.org/10.15585/mmwr.… #MedEd #MedTwitter
Health care providers and public health practitioners should be aware that ocular #monkeypox, although rare, is a sight-threatening condition.
4/8

#MedStudentTwitter #MedicalStudent
Urgent referral for ophthalmologic evaluation & prompt antiviral therapy should be considered for patients with #monkeypox & ocular signs or symptoms (e.g., vision changes or eye pain, itching, redness, swelling, or foreign body sensation) or lesions near the eye.
5/8

#resident
To decrease the risk for autoinoculation, persons with #monkeypox should be advised to practice hand hygiene and to avoid touching their eyes, which includes refraining from using contact lenses
6/8

#medicine
Urgent ophthalmologic evaluation and the provision of timely medical countermeasures for patients with suspected or confirmed ocular #monkeypox might help prevent poor outcomes.
7/8

#Doctor
Clinicians should consider initiation of prompt systemic antiviral therapy as well as topical trifluridine for patients with ocular #monkeypox
8/8

#IDtwitter #microbiology

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More from @guerreroespejo

Oct 20
A 29-YO👨‍⚕️#physician, a needlestick injury with a needle used to collect a fluid sample from a man who had a pustular rash (later confirmed to be #monkeypox), the gloves appeared intact to him
Four days later, a vesicle appeared on the pricked finger (A)
1/7

#MedTwitter #Doctor Image
#Monkeypox virus was identified in its fluid by PCR

MONKEYPOX AFTER OCCUPATIONAL NEDDLESTICK INJURY FROM PUSTULE
2/7

doi.org/10.3201/eid281…
#IDtwitter #MedStudentTwitter
Progress of #monkeypox index lesion:
A) on the 4th day of illness
B) on the 6th day of illness
C) on the 18th day of illness
D) Necrotic scab underneath the devitalized tissue of the index lesion on the 24th day of illness
3/7

#resident #medicine Image
Read 7 tweets
Oct 18
Mujer 55 años, cáncer de mama, quimioterapia: fiebre, bulla purpúrica dolorosa rodeada de eritema en el cuero cabelludo.

El recuento de glóbulos blancos y absoluto de neutrófilos: ⬇️(neutropenia)
1/4

doi.org/10.1503/cmaj.2…
#dermatology #IDtwitter #MedTwitter Image
Hemocultivos: Pseudomonas aeruginosa

ECTIMA GRANGRENOSO en sepsis neutropénica por PSEUDOMONAS AERUGINOSA
2/4

#microbiology #dermatologia #emergency
Al principio, las lesiones de ectima gangrenoso toman la forma de máculas rodeadas de eritema que rápidamente se transforman en ampollas y escaras ulcerativas necróticas.
3/4

#criticalcare #MedStudentTwitter #resident
Read 4 tweets
Sep 21
A 19-YO👩‍🦰, taken care of an 11-YO👦with bronchitis: cough, fever, dyspnea & pneumonia (XR)
Levofloxacin➡️hypoxia resolved, but:
- Orolabial blisters & rash, day 8
- Conjunctivitis, day 9
- Hemorrhagic denuded labial lesions, day 17
1/7

doi.org/10.1093/cid/ci…#IDtwitter #MedEd
🔬skin lesion: interface dermatitis, consistent with erythema multiforme/Stevens-Johnson syndrome–type histological changes
ELISA for M. pneumoniae IgM, initially➖, &➕at day 10

MYCOPLASMA PNEUMONIAE-INDUCED RASH AND MUCOSITIS (MIRM)
2/7

doi.org/10.1093/cid/ci…
#dermatology
Extrapulmonary manifestations of M. pneumoniae infection:
✔️in 10% of patients
✔️mucocutaneous eruptions, central nervous system disease, carditis, hemolytic anemia, and Raynaud disease associated with cold agglutinins, renal disease, or arthritis.

3/7

#MedTwitter #Doctor
Read 7 tweets
Sep 19
A 25-yo woman, cirrhosis due to autoimmune hepatitis, not pneumococcal vaccination: rapidly progressive sepsis with purpura fulminans.

16 h after admission, violaceous non-blanching ecchymoses from proximal thighs to the calves, & flaccid bullae.
1/9

#dermatology #MedEd Image
36 hours after admission, the skin was dusky & violaceous with sharply demarcated borders, bullae filled with red to black-colored fluid

Blood🧫: pan-susceptible Streptococcus pneumoniae.

PNEUMOCOCCAL PURPURA FULMINANS
2/9

doi.org/10.1016/j.idcr…
#IDtwitter #MedTwitter Image
She had progressive hypoxia & shock despite maximal ventilator & vasopressor support, & the patient passed away within 48 h of admission.

Autopsy: a cirrhotic liver, diffuse alveolar damage, & five liters of serous fluid in the abdominal compartment.
3/9

#Doctor #resident
Read 9 tweets
Sep 4
Niño de 4 años: fiebre de dos días, enrojecimiento y edema leve en el pabellón auricular derecho, con posterior aparición de vesículas y ampollas.
1/4

🖊️Agámez SN, Cáceres J.
continuum.aeped.es/screens/play/1…
@ContinuumAEP @aepediatria
#pediatria #Pediatrics #dermatologia
PRIMOINFECCIÓN POR EL VIRUS HERPES SIMPLE TIPO 1
✔️inicio súbito
✔️múltiples vesículas sobre base inflamatoria
✔️a veces ampollas
✔️generalmente en un sitio único
✔️evolucionan a lesiones exudativas y ulcerocostrosas (figuras)
✔️sin secuelas.
2/4

#MedEd #IDtwitter #MedTwitter
Puede acompañarse de fiebre, malestar, afectación del estado general, adenopatía cervical y dolor

✔️La gingivoestomatitis y la faringitis, las manifestaciones más frecuente de la primoinfección, y
✔️el herpes labial, más propio de reactivación
3/4

#Doctor #MedStudentTwitter
Read 4 tweets
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

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