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Jan 24 • 5 tweets • 3 min read
A 24-YO♀️: a 10-year of episodes of redness & photophobia in eyes, &⬇️visual acuity
SLE: conjunctival hyperemia & peripheral corneal opacification, inflammation & crystalline deposits on the corneal
⬇️
INTERSTITIAL KERATITIS
1/5
DOI: 10.1056/NEJMicm1709103
#eye #internalmedicine
Etiologies:
✔️Bacterial: SYPHILIS, Lyme borreliosis, tuberculosis, etc.
✔️Viral: Herpesviridae (HERPES SIMPLEX, H. zoster, E-B)...
✔️Parasitic: Onchocerciasis, Acanthamoeba...
✔️Immune: Cogan's syndrome, contact lens-associated keratitis, autoimmune disease…
2/5
#microbiology
ESR:⬆️& evaluation for infectious causes: unremarkable.
6 months after the diagnosis of interstitial keratitis: vertigo, tinnitus, & hearing loss.
Audiometry: sensorineural hearing loss in both ears.
Clinical findings consistent with COGAN´S SYNDROME
3/5
#Ophthalmology #MedEd
COGAN´S SYNDROME:
📌an inflammatory disorder
📌interstitial keratitis ➕ vestibuloauditory dysfunction.
4/5
#medicine #MedTwitter #Doctor
Treatment with systemic glucocorticoids was initiated.

One month later, improvement of visual acuity and hearing loss.
5/5
#resident #Otolaryngology

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More from @guerreroespejo

Antonio Guerrero Profile picture
Jan 26
9 años ♂️, dermatitis atópica tratada con metrotexato: lesiones vesiculosas en pulgar izq., ganglio axilar izq., y aftas en boca.
1/8
✍️@Mercede49161978, D. Mora, M. Díaz
continuum.aeped.es/courses/info/1…
@ContinuumAEP @aepediatria
#pediatría #dermatología ImageImage
@Mercede49161978 @ContinuumAEP @aepediatria Cultivo exudado de vesículas:➕ para VHS tipo 1.

PANADIZO HERPÉTICO

Recibió aciclovir
2/8
#MIR #AtencionPrimaria
@Mercede49161978 @ContinuumAEP @aepediatria El panadizo herpético empieza con sensación de hormigueo, y puede causar dolor intenso, eritema y edema del dedo; en ocasiones, fiebre y adenopatía.

Aparecen vesículas coalescentes en la falange, generalmente después de 2 o 3 días de comenzado el dolor.
3/8
#infecciosas
Read 8 tweets
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
@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 21
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
Read 4 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

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