A 59-YO DM, steroid, myasthenia gravis with thymoma: headache & deviation of tongue to the R side with fasciculation suggestive of right 12th cranial nerve palsy

CT: sphenoid sclerotic changes, soft tissue density lesion with calcification.
1/9

#neurology #radiology #IDtwitter Image
MRI brain: a hypointense lesion involving the body of sphenoid (R > L) and clivus on T2 weighted images and T1 weighted images with moderate contrast enhancement possibly fungal in aetiology.
2/9

doi.org/10.1016/j.idcr…
#radiologist #radres #MedTwitter ImageImage
Endoscopic sphenoidotomy & debridement: invasive fungal sphenoid sinusitis & CENTRAL SKULL BASE OSTEOMYELITIS involving the clivus

🔬from sphenoid mucosa: morphologically ASPERGILLUS with foci of tissue invasion.
3/9

#microbiology #maxillofacial #Orthopedics
CENTRAL SKULL BASE OSTEOMYELITIS SECONDARY TO INVASIVE ASPERGILLUS SPHENOID SINUSITIS PRESENTING WITH ISOLATED 12TH NERVE PALSY

Oral voriconazole for 10 weeks: On follow-up, symptomatically better, with improvement in 12th cranial nerve palsy.
4/9

#Doctor #MedStudentTwitter
Skull base osteomyelitis is a potentially life-threatening infection, usually seen in elderly immunocompromised patients secondary to malignant otitis externa (MOE) caused by Pseudomonas.
5/9

#MedicalStudents #MedEd
Here this case of skull base osteomyelitis occurred as a complication of sphenoid sinusitis rather than malignat otitis media, caused by invasive Aspergillus infection, with isolated hypoglossal nerve palsy.
7/9

#mycology #resident #medicine
In skull base osteomyelitis cases most patients present with pain & cranial nerve involvement with no obvious infectious source & thereby giving a high suspicion of malignancy.

The crux of management lies in the🔬diagnosis as the imaging findings frequently mimic malignancy
8/9
Central skull base osteomyelitis is a:
📌rare,
📌life threatening condition

and that secondary to invasive aspergillosis presenting with isolated hypoglossal nerve palsy is
📍extremely rare.

#neurology #radiology #IDtwitter

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More from @guerreroespejo

Dec 3
A 5-YO♂️ with a history of IgA vasculitis & a pustular nasal lesions had started scabbing after 2 days of systemic glucocorticoids: progressively painful skin ulcerations of L forearm (A), R calf (B) & R foot (C).
1/4

DOI: 10.1056/NEJMicm2204111
#Pediatrics #dermatology
Biopsy samples from all three lesions showed a dense neutrophilic infiltrate with negative tissue cultures.

PYODERMA GANGRENOSUM
2/4

#MedTwitter #Doctor #MedStudentTwitter
Laboratory & radiographic: no signs of underlying systemic disease, such as cancer, inflammatory bowel disease, or autoimmune conditions.

After 8 months of glucocorticoids: the lesions resolved completely.
¾

#resident #pediatric #MedicalStudents
Read 4 tweets
Dec 3
2022 #Monkeypox #Outbreak:
Confirmed cases, WHO, 02 December 2022

With the exception of West & Central Africa, the outbreak continues to primarily affect:
📌men who have sex with men
📌who have reported recent sex with one or multiple partners.
1/11

worldhealthorg.shinyapps.io/mpx_global/
WHO assesses the #Monkeypox global #Risk as Moderate.

Regionally, risk:
✔️as High in the Americas
✔️as Moderate in the African Region, Eastern Mediterranean Region, European Region & the South-East Asia Region.
✔️as Low in the Western Pacific Region

2/11
The 10 most affected countries:
📌United States of America
📌Brazil
📌Spain
📌France
📌Colombia
📌The United Kingdom
📌Germany
📌Peru
📌Mexico and
📌Canada

Together, these countries account for 86.0% of the #monkeypox cases reported globally.
3/11
Read 11 tweets
Nov 23
A 25-YO♂️ in Nigeria 2 years earlier: recurrent itchy swellings on his hands and forearms, appearing every week or so for the past few months.

What's in the #eye (A) & in the blood (B)?
1/4

doi.org/10.1016/S0140-…
#Ophthalmology #parasitology #microbiology ImageImage
Identification of:
📌an adult worm in the eye
📌the microfilariae on a blood smear

LOA LOA FILARIASIS is a skin and eye disease caused by the nematode worm Loa loa.
2/4

#parasites #MedEd #MedTwitter ImageImage
Loa loa is one of three parasitic filarial nematodes that cause subcutaneous filariasis in humans.
The other two are Mansonella streptocerca and Onchocerca volvulus (causes river blindness).
3/4

#Doctor #MedStudentTwitter #oftalmologia
Read 4 tweets
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
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
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 21
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
Read 8 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

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