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Jan 21 • 4 tweets • 3 min read
A 64-YO ♂️ from a rural community: pain, itching, bleeding in the L ear, & mobile larvae occluding the L external auditory canal
1/4
DOI: 10.1056/NEJMicm2005407
#primarycare #Otolaryngologist Image
AURAL MYASIS
An ear aspirator, forceps, and irrigation with sterile water were used to remove the larvae
Perforation of the tympanic membrane was identified.
2/4
DOI: 10.1056/NEJMicm2005407
#healthcare #parasitology Image
Aural myiasis:
📌infestation of the middle or external ear
📌by fly larvae of the order Diptera.

Risk factors:
✔️chronic otitis media,
✔️diabetes mellitus, and
✔️impaired hygiene.
3/4
DOI: 10.1056/NEJMicm2005407
#Otolaryngology #parasites
Treatment of the patient:
✔️removal of the larvae & irrigation of the ear to expel any remaining organisms
✔️topical & systemic antibacterial agents to prevent secondary infection
⬇️
Symptoms resolved.
4/4
DOI: 10.1056/NEJMicm2005407
#MedTwitter #medicine #MedicalStudents

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More from @guerreroespejo

Antonio Guerrero Profile picture
Jan 23
6 años ♀️, de Marruecos: lesión en la extremidad superior derecha y otra en extremidad inferior izquierda de 7 meses de evolución, indoloras.
1/6
✍️ I Santacreu & @ayats_roser
continuum.aeped.es/screens/play/1…
#pediatría #AtencionPrimaria
@ContinuumAEP @aepediatria ImageImage
@ayats_roser @ContinuumAEP @aepediatria LEISHMANIASIS CUTÁNEA

Recibió antimoniato de meglumina intralesional.
Buena evolución quedando una atrofia residual en el lugar de las lesiones.
2/6
#dermatología #parasitología
@ayats_roser @ContinuumAEP @aepediatria La leishmaniasis se manifiesta con formas cutáneas, mucosas y viscerales

Está causadas por varias especies de protozoos del género Leishmania.
3/6
#medicinainterna #MIR
Read 6 tweets
Antonio Guerrero Profile picture
Jan 20
A 20-YO ♀️, college wrestling, Mexico: itching in the past 2 months, erythematous & fine-scaling papules with annular plaques having a raised border affecting the face, neck, & torso.
1/6
doi: 10.18502/cmm.6.4.5439
#dermatology #primarycare #MedTwitter
KOH: multiple thin & septate hyphae.
🧫, MALDI-TOF-MS: Trichophyton tonsurans
T. tonsurans was isolated in 4 cases belonging to the school fighting team & from one of the training mats

TINEA GLADIATORUM DUE TO TRICHOPHYTON TONSURANS IN A SCHOLL WRESTLING TEAN
2/6
#mycology
Oral terbinafine for 3 weeks: clinical & mycological cure.
Tinea gladiatorum is a type of dermatophytosis that occurs in combat athletes, such as wrestlers and judo fighters, as a result of Trichophyton species.
3/6

doi: 10.18502/cmm.6.4.5439
#IDtwitter #microbiology #Doctor
Read 6 tweets
Antonio Guerrero Profile picture
Jan 15
A 38-YO♂️, #HIV➕: asthenia, fever, & generalized & confluent maculopapular rash predominantly on the back, cervical & inguinal lymphadenopathies, & stippled petechial hemorrhages in the soft palate (Forchheimer’s spots)
Subsequently, pustules appeared

1/5
 #emergency #IDtwitter
Classic Mpox pustules appeared
PCR:
✔️for measles & rubella➖
✔️for Mpox➕

HUMAN Mpox, although confluent maculopapular rash & Forchheimer’s spots have been reported as classic signs of rubella or measles infections
2/5
DOI: doi.org/10.4269/ajtmh.…
#microbiology #MedTwitter
Forchheimer spots, a type of enanthem:
📌sometimes precede the skin rash of rubella.
📌tiny red spots on the soft palate in rubella, measles and scarlet fever.
3/5
#dermatology #internalmedicine #primarycare
Read 5 tweets
Antonio Guerrero Profile picture
Jan 13
A 27-YO ♀️, fever and PCR + for #SARSCoV2: One week later, she developed migratory, pruritic urticarial erythematous plaques (wheals) on her face, limbs, trunk, palms & soles, and angioedema of her lips.
¼

DOI: doi.org/10.1503/cmaj.2…
#dermtwitter #IDtwitter #MedTwitter
Treated with cetirizine, 12 weeks later, she was still having episodes of urticaria
The most likely diagnosis was CHRONIC SPONTANEOUS URTICARIA TRIGGERED BY SARS-CoV-2, but other considerations were urticarial vasculitis and chronic inducible urticaria.
2/4
#dermatology #Doctor
Urticaria is commonly triggered by viral & bacterial infections, including herpes simplex virus, cytomegalovirus, Epstein–Barr virus, HIV & mycoplasma.

It commonly precedes or occurs concurrently with COVID-19, but can rarely occur after symptoms have resolved.
3/
#virology
Read 4 tweets
Antonio Guerrero Profile picture
Jan 11
A 32-YO♀️ from Guatemala, Ph+ B-ALL post #chemotherapy: #dyspnea
CT: ground-glass opacities (2A yellow box), interstitial pulmonary edema with septal thickening (2B yellow circles), & pericardial effusion (2C yellow arrows), lymph nodes (2D yellow arrows)
Eosinophilia
1/7
Due to normal ejection fraction, the differential diagnosis of dyspnea included non-cardiogenic pulmonary edema, pneumonitis secondary to chemotoxicity, and infection.
2/7
doi.org/10.1016/j.idcr…
#haematology #radiology #IDtwitter
She progressed to acute hypoxic respiratory failure.

🔬bronchoalveolar lavage: numerous larvae (3A,3B) with short buccal grove (arrow head) and prominent genital primordium (arrow) consistent with STRONGYLOIDES HYPERINFECTION

3/7
 #lungdisease #parasitology #Pathologists
Read 7 tweets
Antonio Guerrero Profile picture
Jan 9
A 4-YO♂️ treated for tuberculosis for 3 years with chronic cough, kyphosis, recurrent pneumonia, rib osteomyelitis: lung consolidation, mediastinal lymphadenopathy, cervical kyphosis; R-sided paravertebral soft tissue swelling (T3 to T6)
1/7
#IDtwitter #radiology #Orthopedics
Serology: ➕for Aspergillus flavus & Aspergillus fumigatus.
Aspiration of the paravertebral soft tissue:
🔬granulomatous inflammation
🧫Acinetobacter spp.

VERTEBRAL OSTEOMYELITIS & ACINETOBACTER SPP PARAVERTEBRAL SOFT TISSUE INFECTION
2/7
#microbiology #MedTwitter
Nitroblue tetrazolium dye reduction test: no reduction of the nitroblue tetrazolium
No right shift noted in the activated neutrophils in flow cytometry-based DHR assay (E, patient; F, control)

CHRONIC GRANULOMATOUS DISEASE
3/7
DOI: 10.1097/INF.0000000000001221
#medicine
Read 6 tweets

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