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

🔬: showed invasion of X?
1/8

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
2/8

#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
3/8

#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.
5/8

#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.
6/8

#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.
7/8

#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.
8/8

#MedEd #MedStudentTwitter

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More from @guerreroespejo

Nov 22
A 17-MO♀️, Morocco: fever, pallor, epistaxis, gingival petechiae, lower limbsedema, & hepatosplenomegaly.

Pancytopenia, hypoalbunemia.
Triglyceridemia, ferritinemia, LDH & fibrinogen:⬆️
PT⬇️
Direct Coombs test:➕

🔬myelogram: ?
1/9

#parasitology #haematology #Pediatrics ImageImage
Myelogram revealed the presence of leishmania bodies and figures of hemophagocytosis.

VISCERAL LEISHMANIASIS ASSOCIATED WITH MACROPHAGE ACTIVATION SYNDROME
2/9

doi.org/10.1016/j.idcr…
#Pathologists #microbiology #IDtwitter Image
The patient was put on liposomal amphotericin B and corticosteroid therapy with good clinical and biological evolution.
3/9

#MedTwitter #Doctor
Read 9 tweets
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
Al cabo de unos días: NECROSIS AURICULAR BILATERAL
SECUNDARIA A #COCAÍNA ADULTERADA CON LEVAMISOL

2/6
dx.doi.org/10.4321/s0376-…
#dermatología #Cirugíaplástica
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 13
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
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

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