An 85-YO👨‍🦳, chronic kidney disease, gouty arthritis: fever, neck pain & stiffness.

WBC & CRP:⬆️
MRI suggested cervical meningitis (A): enhancement along the epidural space (arrows), & thin enhancement in a portion of the meninges (arrowheads).

1/5
#neurology #radiology
CSF: not meningitis, & CSF🧫& molecular tests ➖ for bacteria & mycobacteria

CT: calcifications of the transverse ligament of the atlas (B).

Diagnosed with crowned dens syndrome: 20 mg prednisolone, & his symptoms dramatically improved.
2/5

#rheumatology #radres #emergency
However, CSF examination under polarising microscopy revealed monosodium urate crystals (C).
Dual-energy CT confirmed the calcifications to be monosodium urate crystals (D).
Uric acid:⬆️
MONOSODIUM URATE CRYSTALS IN CSF THAT CAUSED MENINGITIS-LIKE SYMPTOMS
3/5
#neurology #MedEd
Crowned dens síndrome is:
📌a rare finding in calcium pyrophosphate deposition disease
📌typically encountered in elderly patients and
📌could be clinically similar to meningitis
4/5

DOI:doi.org/10.1016/S2665-…
#IDtwitter #MedTwitter #radres
The patient:
📌history of gout, &
📌monosodium urate crystals by CSF analysis & dual-energy CT,
suggesting GOUT FLARE IN THE CERVICAL SPINE

Intrathecal monosodium urate crystal formation can cause meningitis-like symptoms in patients with gout history.
5/5

#resident #medicine

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More from @guerreroespejo

Nov 9
👧de 7 años, picadura de #garrapata (fig.) en el sur de #España: febrícula, astenia, múltiples ganglios linfáticos cervicales laterales y posteriores, y escara negra rodeada de eritema en la región occipital (fig.).
1/5

DOI: 10.1016/j.anpedi.2020.03.010
#pediatría #dermatología ImageImage
La niña fue diagnosticada de linfadenopatía transmitida por garrapatas, TIBOLA (TIck-BOrne LymphAdenopathy).

Claritromicina de 5 días: asintomática un mes después. La escara negra desapareció a las 5 semanas.
2/5

#AtenciónPrimaria #urgencias #MedEd
TIBOLA
✔️enfermedad emergente en Europa
✔️causada mayoritariamente por Rickettsia slovaca (también por R. rioja, R. sibirica mongolotimonae, R. massiliae, Bartonella haenselae y Francisella tularensis) y
✔️transmitida por garrapatas Dermacentor

3/5
#microbiología #microbiology
Read 5 tweets
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
#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
Read 8 tweets
Oct 19
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
Read 8 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

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