An 81-YO👵, type 2 DM: malaise, fever & anorexia, with oral pain & odynophagia, yellowish-white, pseudomembranous lesions on the tongue (A)

#endoscopy showed multiple shallow ulcers with a white coating (B)
1/6

doi.org/10.1503/cmaj.2…
#emergency #gastroenterology #MedEd
Glossal & esophageal🔬: multinucleated cells with moulded, ground-glass nuclei

PCR & immunohistochemical staining of the specimens: ➕ for herpes simplex virus type 1 (HSV-1)

HERPETIC GLOSSITIS AND ESOPHAGITIS
2/6

#GIPath #IDtwitter #microbiology
Her hemoglobin A1c was 7.2%.

Doctors treated her with a 7-day course of acyclovir, intravenously because of her odynophagia, and the oral and esophageal lesions completely resolved.
3/6

#MedStudentTwitter #MedicalStudents
Herpes labialis is the most common manifestation of HSV-1 infection, accounting for about 90% of reactivated infections.

In contrast, herpetic glossitis and esophagitis are uncommon manifestations of HSV-1 infection.
4/6

#resident #medicine #MedTwitter
Findings of herpetic glossitis including:
✔️single or multiple vesicles
✔️ulcers
✔️linear or crosshatched fissures &
✔️pseudotumoral plaques

Differential diagnosis:
✔️oral candidiasis
✔️syphilis
✔️tuberculosis
✔️pemphigus
✔️lichen planus &
✔️hairy leukoplakia
5/6

#virology
Herpetic glossitis can coexist with herpetic esophagitis,

Herpetic esophagitis characteristically manifests as well-circumscribed ulcers that are sometimes described as having a volcano-like appearance.
6/6

#GITwitter #resident #medicine #Doctor

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More from @guerreroespejo

Nov 14
46 años ♂️, consumo de #cocaína: dolor en ambos pabellones auriculares con color violáceo.

La prueba de tóxicos en orina:➕a cocaína y benzodiacepinas
1/

dx.doi.org/10.4321/s0376-…
#urgencias #AtencionPrimaria Image
Al cabo de unos días: NECROSIS AURICULAR BILATERAL
SECUNDARIA A #COCAÍNA ADULTERADA CON LEVAMISOL

2/6
dx.doi.org/10.4321/s0376-…
#dermatología #Cirugíaplástica Image
La #cocaína en #España:
📌 adulterada en el 82,5% de la dosis con otro tipo de sustancias como el levamisol, la fenacetina y la cafeína.
📌Desde 2009, un aumento de cocaína adulterada con levamisol
3/6

#MIR #EducaciónMédica
Read 6 tweets
Nov 12
A 26-yo👩‍🦰, #sexually active, with 1 partner: right knee and metacarpal arthralgia, tenosynovitis and pustules on her hand.

CT: an abscess on her chest wall
1/9

doi.org/10.1503/cmaj.2…
#IDtwitter #MedTwitter #emergency Image
✔️Urine gonococcal nucleic acid amplification test (NAAT):➕
✔️🧫from the patient’s chest wall fluid:➖but
✔️16S rRNA with gene sequencing confirmed presence of Neisseria gonorrhoeae.

CHEST WALL ABSCEST WITH DISSEMINATED GONOCOCAL INFECTION
2/9

#microbiology #MolBiol
Her doctors treated her with incision and drainage and intravenous ceftriaxone 2 g/d. for 17 days after resolution of the abscess

If chlamydia infection has not been ruled out, chlamydia treatment with doxycycline for 7 days should be added.
3/9

#surgery #MedStudentTwitter
Read 9 tweets
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
Nov 8
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
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

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