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Antonio Guerrero Profile picture
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Dec 26 • 4 tweets • 3 min read
A 77-YO ♂️, 2 weeks before herpes zoster on the right T3 and T4 dermatomes, celecoxib to treat new-onset back pain: a coalescing, erythematous eruption that spared the skin surrounding crusted herpes zoster lesions
¼

DOI: 10.1056/NEJMicm2205584
#IDtwitter #dermatology
Skin-biopsy: consistent with a drug rash
Patch testing identified celecoxib as the trigger.

REVERSE ISOTOPIC RESPONSE in a drug rash sparing a healed herpes zoster infection.
2/4
#MedTwitter #dermtwitter #Doctor
A reverse isotopic response or an isotopic nonresponse occurs when:
✔️a new skin disorder by an unrelated disease
✔️spares the area of skin previously affected, healed dermatosis.

The mechanism of this phenomenon is unclear.
3/4
#MedStudentTwitter #resident
10 days after oral glucocorticoids and stop taking celecoxib: the diffuse rash had completely resolved.
4/4
#medicine #MedicalStudents #MedEd

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More from @guerreroespejo

Antonio Guerrero Profile picture
Dec 15
Lactante♀️, 20 meses: fiebre, sialorrea, lesión costrosa hemática con contenido purulento y restos de costras melicéricas, eritema, edema y lesiones vesiculosas en 2º dedo de la mano, adenopatías epitrocleares, vesículas en paladar y aftas en encías
1/5
#pediatria #infecciosas
El PANADIZO HERPÉTICO es una lesión cutánea producida, especialmente en pediatría, por el virus herpes simple tipo 1.
2/5
pap.es/articulo/13681…
#AtencionPrimaria #microbiología
La presentación clínica habitual es una lesión con vesículas arracimadas, cuya localización típica es en primer o segundo dedo.

En los pacientes pediátricos es frecuente que se produzca tras autoinoculación desde una gingivoestomatitis herpética.
3/5
#MIR #EducaciónMédica
Read 5 tweets
Antonio Guerrero Profile picture
Dec 14
A 12-MO♀️ girl, immunization for hepatitis B, 2 weeks prior: a rapidly spreading, nonblanching, nonpalpable, purpuric rash over legs & cheeks surrounded by edema, 37.6°C, nontoxic in appearance

Leukocytosis,⬆️CRP
1/9
#dermatology #Emergency #Pediatrics doi.org/10.1093/cid/ci…
The next day, the hemorrhagic rash became palpable
Pharyngeal PCR:➕for enterovirus
🔬 of purpuric lesions: leukocytoclastic vasculitis, & DI studies showed vascular wall fibrinogen deposition, consistent with ACUTE HEMORRHAGIC EDEMA OF INFANCY (AHEI)
2/9
#pediatric #IDtwitter
Typical patient of ACUTE HEMORRHAGIC EDEMA OF INFANCY:
✔️6–24 months of age,
✔️during winter,
✔️nontoxic presentation,
✔️low-grade fever,
✔️abrupt onset of large purpuric skin lesions,
✔️and edema in face and extremities
3/9
doi.org/10.1093/cid/ci…
#MedTwitter #pediatria
Read 9 tweets
Antonio Guerrero Profile picture
Dec 12
A 65-YO man, from North African: asymptomatic dorsolumbar mass for 30 years with normal skin appearance.

MRI: ?
1/6
doi.org/10.1093/cid/ci…
#radiology #MedTwitter #parasitology
MRI: a multivesicular cyst in the latissimus dorsi muscle (arrow)

🧪for Echinococcus granulosus: ELISA, & Western blot➕
Surgery: multiple daughter vesicles of E. granulosus, with the presence of multiple scolices

INTRAMUSCULAR HYDATID CYST
2/6
#parasites #medicine #radres
No puncture should be performed, to avoid dissemination of the cysts that can cause an anaphylactic shock.

The patient received 3 other courses of albendazole: serologic control became negative after 1 year.
3/6
#IDtwitter #surgery
Read 6 tweets
Antonio Guerrero Profile picture
Dec 10
A 35-YO♂️: a 9-month of white concretions encircling the hairs in both axillae (A).

A Wood’s lamp🔎: yellow-green fluorescence of the concretions (B).

Dermoscopy: cottonlike structures on the hair shafts (C).
1/6
DOI: 10.1056/NEJMicm2206453
#dermatology #dermatología Image
TRICHOMYCOSIS AXILARIS

✔️ a superficial bacterial infection of the hair of the axillae
✔️misnomer, given that it is caused by corynebacterium species as opposed to fungi.
2/6
#dermtwitter #microbiology
After 1 week of treatment with topical clindamycin and a daily benzoyl peroxide wash, the patient’s symptoms abated and did not recur.
3/6
#MedTwitter #MedStudentTwitter
Read 6 tweets
Antonio Guerrero Profile picture
Dec 8
Lactante, 9 meses: lesiones peribucales, edema palpebral, conjuntivitis, xerosis peribucal con costras melicéricas, eritrodermia generalizada y lesiones en cuello, extremidades superiores y glúteos, con signo de Nikolsky +.
1/5
#pediatria #AtencionPrimaria #urgencias
SINDROME DE PIEL ESCALDADA ESTAFILOCÓCICA (Enfermedad de Ritter).

📌frecuente en < 5 años,
📌eritrodermia con signo de Nikolsky
📌conjuntivitis y edema facial con descamación periorificial.
2/5
continuum.aeped.es/screens/play/1…
@ContinuumAEP @aepediatria #infecciosas #microbología
@ContinuumAEP @aepediatria La enfermedad de Ritter está causada por cepas de estafilococo productoras de toxinas que se dirigen al complejo desmogleína 1 en la zona granulosa de la epidermis, provocando la exfoliación de la piel.
3/5
#MIR #MedTwitter
Read 5 tweets
Antonio Guerrero Profile picture
Dec 5
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
Read 8 tweets

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