Thread by @guerreroespejo

A 63-year old man, kidney transplantation: fever and a painful ulcer on the lateral side of the tongue.

🔬: showed invasion of X?
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doi.org/10.1016/j.idcr…
#OralPath #maxillofacial #nephrology

🔬 showed invasion of Cryptococcus neoformans.

A tongue swab:➕for HSV-1.

The cryptococcal antigen test on serum: ➕

CRYPTOCOCCOSIS TONGUE ULCER IN A RENAL TRANSPLANT PATIENT
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#mycology #Pathologists #microbiology

A CT-scan of the lungs showed extensive ground glass lesions & a lesion of 4.7 cm in the left upper lobe.

Bronchoalveolar lavage:➕for Cryptococcus neoformans & Pneumocystis jirovecii.

LUNG COINFECTION OF C. NEOFOMANS & P. JIROVECII
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#IDtwitter #MedTwitter

No malignant cells were seen in the bronchoalveolar lavage fluid.

Treatment:
- IV with liposomal amphotericin B & flucytosine followed by long term fluconazole & local amphotericin B suspension.
- co-trimoxazole to treat the Pneumocystis jirovecii pneumonia.
4/8

#Doctor

Immunosuppression consisting of prednisone and mycophenolate mofetil was temporarily switched to prednisone monotherapy.

Over the next 6 weeks the ulcer healed completely.
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#MedStudentTwitter #MedicalStudents

After clinical recovery a follow-up CT scan showed a persistent solid lesion in the lung.

Additional analysis revealed a papillary adenocarcinoma, which was treated with curative radiotherapy.
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#resident #medicine

Cryptococcosis occurs mainly in immunocompromised patients and often leads to meningitis.
Other manifestations:
✔️ include pulmonary,
✔️dermal and
✔️gastrointestinal complaints.
Localization of the tongue is a very rare manifestation.
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#MedEd

Remarkable presentation of coinfections, twenty-two years after kidney transplantation.

The sudden occurrence of several opportunistic infections many years after transplantation might suggest an malignancy.
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#MedEd #MedStudentTwitter