A 71-YO therapy for multiple mieloma, voriconazole for Aspergillus fumigatus sinusitis, prophylaxis with TMP-SMX: febrile neutropenia, nodular lesion on abdominal wall
CT: pulmonary nodule unchanged in last a month
🔬biopsy of pulmonary nodule?
1/8

#Pathologists #haematology Histopathology of the fine-...Image
🔬: Histiocytic process with granular basophilic cytoplasm and Michaelis-Gutmann bodies (arrows), positive for calcium with von Kossa special stain (arrowhead); findings pathognomonic for malakoplakia.

PULMONARY MALAKOPLAQUIA
2/8

doi.org/10.1093/cid/ci…
#pathTwitter
🧫of the pulmonary nodule:➖
🧫biopsy of the abdominal wall lesion: Rhodococcus equi resistant to TMP-SMX, but susceptible to rifampicin, vancomycin, azithromycin, ciprofloxacin, & imipenem.
RHODOCOCCUS EQUI SUBCUTANEOUS ABSCESS
3/8

doi.org/10.1093/cid/ci…
#microbiology
She was commenced on a prolonged course of oral rifampicin 300 mg twice daily and azithromycin 500 mg daily with resolution of the skin lesion and radiological reduction in the size of the pulmonary nodule.
4/8

#IDtwitter #MedTwitter
Rhodococcus equi is a gram-positive coccobacillus in the Nocardioform family. The most common clinical manifestation of R. equi is pulmonary, where it has been associated with nodules, pneumonia, cavitation, and abscess formation.
5/8

#Doctor #MedStudentTwitter
Malakoplakia: rare inflammatory condition most commonly associated with E. coli infection, but is only occasionally seen with R. equi infection

It occurs after ingestion of the organism by host macrophages, a failure of intracellular killing & accumulation of histiocytes.
6/8
The retained bacteria in the lysosomes result in the classically described Michaelis-Gutmann bodies, pathognomonic for malakoplakia: concentrically layered basophilic inclusions, which appear target-like & are + with periodic acid-Schiff stain & von Kossa stain.
7/8

#pathology
Rhodococcus equi is usually susceptible in vitro to trimethoprim-sulfamethoxazole, amikacin, gentamicin, vancomycin, erythromycin, rifampicin, & ciprofloxacin

It has been recommended to treat until after symptoms & radiologic findings have resolved.
8/8

#medicine #MedEd

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Feb 23
A 26-YO♂️ no #sexual contacts other than with his male partner: 6-day of fever, malaise, a swollen parotid gland, & ulcerative lesion on the ipsilateral lower lip.

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Feb 22
A 58-YO♂️, DM, fever & L lower quadrant abdominal pain 2 months prior: acute R-sided back pain, & 3/6 diastolic murmur at R upper sternal border.

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doi.org/10.1016/j.idcr…
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Feb 21
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thelancet.com/journals/lanin…
In this study, authors report the emergence and sustained transmission of #XDR and #MDR strains of S flexneri among among MSM, harbouring plasmid-encoded blaCTX-M-27, in England since September, 2021.

There were clinically severe cases, including hospitalisations.
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Comparison to the XDR S. sonnei outbreak revealed epidemiological and #plasmid similarities and provided support for horizontal acquisition events in a community transmitting infection.
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Feb 17
A 57-YO Mexican♀️, works on a farm has several pets, including dogs, at home: epigastric fullness, and a 15-pound weight loss.

CT: complex cystic left liver mass.
1/5

doi.org/10.1093/cid/ci…
#gastroenterology #radiology #medicine
Resection: Cyst wall (red➡️), daughter cysts (*) normal liver tissue (yellow⬅️)
🔬acellular laminated wall (*), inner germinal layer (black⬅️), & protoscoleces surrounded by a broad capsule (green⬅️). Refractile hooklets (blue⬅️) & calcareous bodies (red⬅️)
2/5
#GIPath #IDtwitter
ECHINOCOCCAL CYST

The patient underwent total excision of the cyst followed by albendazole therapy for 4 weeks.
3/5

doi.org/10.1093/cid/ci…

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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
Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
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doi.org/10.1093/cid/ci…
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Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.

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3/9

#bacteriology #IDtwitter #microbiología
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Feb 14
13 años ♂️: lesiones verrugosas en mucosa oral de 2 años de evolución, con progresivo aumento en tamaño y número.
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🖊️Alonso P, Vázquez A, Santos JL.
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@ContinuumAEP @aepediatria
#pediatria #dentista #AtencionPrimaria
@ContinuumAEP @aepediatria HIPERPLASIA EPITELIAS FOCAL o ENFERMEDAD DE HECK:
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#infecciosas #microbiología #MIR
@ContinuumAEP @aepediatria ✔️Es una proliferación epitelial benigna, ✔️asintomática,
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La frecuencia de esta enfermedad varía ampliamente de una región geográfica y grupo étnico a otro.
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#healthcare #MedicinaInterna
Read 7 tweets

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