13 años ♂️: lesiones verrugosas en mucosa oral de 2 años de evolución, con progresivo aumento en tamaño y número.
1/7

🖊️Alonso P, Vázquez A, Santos JL.
continuum.aeped.es/screens/play/1…
@ContinuumAEP @aepediatria
#pediatria #dentista #AtencionPrimaria
@ContinuumAEP @aepediatria HIPERPLASIA EPITELIAS FOCAL o ENFERMEDAD DE HECK:
📌infección viral rara de la mucosa oral
📌causada por el virus del papiloma humano, especialmente los subtipos 13 o 32.
2/7

#infecciosas #microbiología #MIR
@ContinuumAEP @aepediatria ✔️Es una proliferación epitelial benigna, ✔️asintomática,
✔️ múltiples pápulas de 3 a 10 mm con color de mucosa oral normal.

La frecuencia de esta enfermedad varía ampliamente de una región geográfica y grupo étnico a otro.
3/7

#healthcare #MedicinaInterna
@ContinuumAEP @aepediatria Las pápulas (a veces ligeramente blanquecinas) pueden confluir en placas originando un aspecto de la mucosa «en empedrado»

La proliferación epitelial benigna se presenta principalmente en niños y adultos jóvenes.
4/7

#EducaciónMédica #Medicina
@ContinuumAEP @aepediatria Es más frecuente en algunos grupos étnicos (población indígena americana y esquimal, ...), así como en pacientes inmunodeficientes.

Factores genéticos, medioambientales y nutricionales pueden contribuir a su desarrollo
5/7

#dermatología
@ContinuumAEP @aepediatria Diagnósticos diferenciales de otras manifestaciones del VPH incluyen papiloma viral, verruga vulgar y condiloma acuminado.

El diagnostico del condiloma acuminado en niños, sugiere la posibilidad de abuso sexual.
6/7

#pediatria #urgencias #dermtwitter
La mayoría de las lesiones de la hiperplasia epitelial focal se resuelven sin tratamiento, pero en algunos casos persistentes o recidivantes, está indicado el tratamiento quirúrgico, crioterapia, láser, interferón o imiquimod tópicos.
7/7

#dermatology #dermpath

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More from @guerreroespejo

Feb 15
A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.
1/9

#rheumatology #internalmedicine #dermatology Image
Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
2/9

doi.org/10.1093/cid/ci…
#microbiology #rheumatologist Image
Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.

RAT BITE FEVER (RBF) WITH SEPTIC ARTHRITIS DUE STREPTOBACILLUS MONILIFORMIS
3/9

#bacteriology #IDtwitter #microbiología
Read 9 tweets
Feb 12
A 17-YO♀️, unprotected #sexual intercourse with multiple male partners: a 1-month history of pruritic genital lesions, multiple smooth, grayish-white papules & plaques were noted on the vulva & upper inner thighs.
1/5

DOI: 10.1056/NEJMicm2207538
#gynecology #womenshealth Image
A Treponema pallidum particle agglutination assay:➕
Rapid plasma reagin titer: ➕1:16.

CONDYLOMA LATA OF SECONDARY SYPHILIS
2/5

#microbiology #gynecologist #primarycare
✔️Testing for other sexually transmitted infections, including HIV infection: ➖

✔️Counseling on the importance of condom use

✔️IM penicillin G benzathine
At the 1-month follow-up visit, the lesions had resolved, and the RPR was 1:8.
3/5

#dermtwitter #IDtwitter #MedTwitter
Read 5 tweets
Feb 11
A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter
CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter
🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis

SPLENIC TUBERCULOSIS
3/5

#bacteriology #MedTwitter #GIPath
Read 5 tweets
Feb 10
A 17-YO: a 3-week of dizziness, headache, & weakness of the R leg

MR: ring-enhancing lesions in the frontal lobe & basal ganglia on the L side (A; T1-W) as well as surrounding edema & midline shift (B; T2-W)
1/6

DOI: 10.1056/NEJMicm2202196
#neurology #radiology #IDTwitter
IgG ab for Echinococcus multilocularis & E. granulosus: ➖

Surgical excision🔬: necrotic tissue, granulomatous inflammation, echinococcal laminated membrane (C, arrow) & an intact cyst (D, arrow)

RT-PCR: ➕for E. multilocularis
2/6

#parasitology #Pathologists #pathology
CT imaging of the chest and abdomen did not show any other sites of disease.

CEREBRAL ALVEOLAR ECHINOCOCCOSIS
3/6

DOI: 10.1056/NEJMicm2202196
#microbiology #MedTwitter #Doctor
Read 6 tweets
Feb 9
A 14-yo ♂️ lived on a farm: a 1-month history of episodic headaches, vomiting, & papilledema
MR: a multiloculated cyst of the brain (A) with a hypointense rim and small projections in T2 phase (B, arrow)
1/5

DOI: 10.1056/NEJMicm2208104
#neurology #radiology #pediatric Image
Findings suggestive of CYSTIC ECHINOCOCCOSIS.

CT of the body: no other sites of disease.
A craniotomy was performed, during which saline irrigation was used to separate the cyst wall from the brain to avoid rupture.
2/5

DOI: 10.1056/NEJMicm2208104
#IDtwitter #parasitology Image
🔬: an echinococcal laminated membrane lined by a germinal layer with daughter cysts (Panel D, arrows) and protoscolices (inset, arrows) with hooklets (arrowhead).

PRIMARY CEREBRAL CYSTIC ECHINOCOCCOSIS FROM ECHINOCOCCUS GRANULOSUS
3/5

#microbiology #Pathologists #pathology Image
Read 5 tweets
Feb 7
A 50-YO♂️of North India, visited bat caves & a bird sanctuary in Thailand: multiple plaques & nodules on his face, neck, arms & trunk with hoarseness, fever, weight loss for months
Laryngoscopy: nodules over the tonsils & posterior pharyngeal wall
1/4

#medicine #dermatology
Skin & laryngeal 🔬: histiocytes with intracellular & extracellular PAS+ yeast cells
Skin biopsy🧫: tuberculate macroconidia confirmed as H. capsulatum var. capsulatum
Ab against Histoplasma by ID:➕

DISSEMINATED HISTOPLASMOSIS
2/4

doi.org/10.3109/136937…
#mycology #IDtwitter
Disseminated histoplasmosis involving skin & larynx in an apparently immunocompetent individual

The infection appeared to be imported from Thailand.

The patient responded very well to intravenous amphotericin B followed by itraconazole.
3/4

#microbiology #MedTwitter #Doctor
Read 4 tweets

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