A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?
1/7

#IDTwitter #microbiology Wide spread papules and nodules over face. Similar lesions w
🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.

PROGRESSIVE DISSEMINATED HISTOPLASMOSIS
2/7

doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine 1.- Histologic section of skin lesion showing sheets of macr
Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate
3/7

#MedTwitter #Doctor
Intravenous deoxycholate amphotericin B and itraconazole prophylaxis in view of low CD4 cell counts. The treatment cycle of amphotericin B was repeated after 3 weeks.

Fever subsided, general condition improved & he was free of skin lesions
4/7

#MedStudentTwitter #medicine
The disease is endemic in North America, Central and South America.
However, the disease is being reported frequently from nonendemic areas as well especially among immunocompromised individuals and returning travelers
5/7

#MedicalStudents #MedEd
This immunecompromised patient, taking treatment for suspected pulmonary tuberculosis without benefit, had classic progressive disseminated histoplasmosis presenting with pulmonary histoplasmosis and widespread cutaneous involvement.

6/7
#bacteriology #dermatology
In immunocompetent hosts, when disseminated histoplasmosis occurs from pulmonary infection, oral ulcers, nodules, & vegetative plaques are common, and dissemination to liver, spleen, bone marrow, & other organs is frequent
7/7

doi: 10.4269/ajtmh.17-0432
#resident #dermtwitter

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More from @guerreroespejo

Feb 1
A 46-YO ♂️: oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health.

Needle aspiration from submandibular lymph node: intra- and extracellular yeasts
1/4

DOI:
doi.org/10.4269/ajtmh.…
#dermpath #mycology Mucocutaneous examination s...Image
The histopathology of oral lesion showed features of HISTOPLASMOSIS confirmed later from culture of Histoplasma capsulatum on culture
2/4

#IDtwitter #microbiology #MedTwitter Fine needle aspiration cyto...
In immunocompetent hosts, when chronic disseminated histoplasmosis occurs from pulmonary infection, oral ulcers, nodules, and vegetative plaques are common and dissemination to liver, spleen, bone marrow, and other organs is frequent.
3/4

#Doctor #MedStudentTwitter #resident
Read 4 tweets
Jan 30
39 años ♂️: hiperqueratosis subungueal y coloración amarillo-verdosa de la lámina ungueal del 5º dedo de pie dcho. de 2 años de evolución.

1/ 7

✍️B. Monteagudo, O. Figueroa, @olaya_sm, S. Méndez
DOI: 10.1016/j.ad.2018.04.013
#dermatología #microbiología
@olaya_sm Con 🔍: Hiperqueratosis subungueal (&), borde distal irregular, zonas parduzcas de aspecto hemorrágico (&) y patrón multicolor de lámina ungueal con áreas verdes ($) y azul-negruzcas (*), y otras longitudinales amarillentas (→)

CLORONIQUIA
2/7

#dermatology
@olaya_sm 🧫 uña: Pseudomonas aeruginosa y hongo filamentoso (imposible identificar por sobrecrecimiento bacteriano).

UÑA VERDE CAUSADA POR ONICOMICOSIS COINFECTADA POR PSEUDOMONAS AERUGINOSA

Con ciprofloxacino oral y terbinafina, tres meses: resolución.
3/7

#AtencionPrimaria #micología
Read 6 tweets
Jan 29
A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles
1/7

#IDtwitter #primarycare ImageImageImage
PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3

#MPOX (MONKEYPOX)
2/7

#healthcare #internalmedicine #microbiology
doi.org/10.1016/j.idcr…
Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.
3/7

#MedTwitter #MedStudentTwitter #dermtwitter
Read 7 tweets
Jan 28
A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes
1/5

#IDtwitter #primarycare #healthcare
HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus

MPOX (MONKEYPOX)
2/5

#internalmedicine #microbiology doi.org/10.1016/j.idcr…
Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas
3/5

#MedTwitter #MedStudentTwitter #dermtwitter
Read 5 tweets
Jan 27
An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.
1/6

#internalmedicine #IDtwitter Image
Skin biopsy🔬: bilateral invasive squamous cell carcinomas.

BILATERAL INVASIVE SQUAMOUS CELL CARCINOMAS (MARJOLIN ULCERS)
2/6

#dermatology #dermpath
doi.org/10.1093/cid/ci… Image
The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.
3/6

#Doctor #healthcare #MedStudentTwitter
Read 6 tweets
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
@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

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