Antonio Guerrero Profile picture
Apr 11, 2023 19 tweets 8 min read Read on X
An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB
Mycobacterial🧫:➖
1/19

#IDtwitter #dermatology ImageImage
A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).
2/19

DOI: doi.org/10.1128/jcm.00…
#dermpath #microbiology (A) Skin biopsy specimen, h...
Molecular identification: 100% identity to multiple Mycobacterium leprae

BORDERLINE LEPROMATOUS LEPROSY WITH REVERSAL REACTION
3/19

#MedTwitter #MolBiol
Prednisone & methotrexate for treatment of reversal reaction, & 10 days later, rifampin, minocycline, & moxifloxacin were added for treatment of leprosy

3 months into therapy: a significant improvement, & he gradually returned to his baseline functional status
4/19
#Doctor Image
New cases of Leprosy, or Hansen’s disease, caused by Mycobacterium leprae or Mycobacterium lepromatosis in 2020:
✔️127,558 globally, with the highest numbers of cases reported in India, Brazil, and Indonesia
✔️159 in the US
5/19

#MedStudentTwitter #resident
M. leprae:
✔️a acid-fast, intracellular pathogen that most frequently invades Schwann cells in peripheral nerves & macrophages in the skin
✔️M. leprae DNA was detected from skeletal remains from over 4,000 years ago (the first bacterium found to cause disease in humans)
6/19
Nine-banded armadillos (Dasypus novemcinctus) serve as a zoonotic reservoir for human infection and are considered responsible for some transmission of indigenous cases of leprosy in the United States
7/19

#medicine #MedicalStudents
A classification system divides leprosy, based on a spectrum of cell-mediated responses to the disease, into 5 subtypes:
✔️tuberculoid,
✔️borderline tuberculoid,
✔️mid-borderline,
✔️borderline lepromatous, &
✔️lepromatous
8/19

#MedEd #MIR
A simpler WHO classification system exists that divides leprosy, based on number of lesions, into
✔️paucibacillary (5 lesions or less) and
✔️multibacillary (more than 5 lesions) leprosy and can be helpful for determining treatment duration
9/19

DOI: doi.org/10.1128/jcm.00…
🔬of tuberculoid infections: well-formed granulomas with epithelioid cells, nerve infiltration, & few bacilli
🔬On lepromatous: disorganized granulomas & foamy macrophages with many bacilli, which appear as circular aggregates of bacilli on AFB stains.
10/19

#EducaciónMédica
The borderline forms may have features of both tuberculoid and lepromatous leprosy.

Histopathology in the patient’s case showed poorly defined, granulomatous inflammation with evidence of high bacillary load, suggestive of disease on the lepromatous side of the spectrum.
11/19
Immunologic reactions in leprosy can occur during treatment or spontaneously during the disease course and are associated with increased morbidity.
There are two types of immune reactions.
12/19

#Medicina
The type 1 reaction, or reversal reaction, is a delayed-type hypersensitivity reaction associated with increased erythema of lesions, edema of the hands & feet, neuritis, and nerve impairment, & most often occurs in borderline forms of leprosy.
13/19

#AtencionPrimaria
The type 2 reaction, or erythema nodosum leprosum, is an immune complex-mediated reaction causing systemic symptoms, including fevers with eruption of multiple, painful subcutaneous nodules, & tends to occur in borderline or lepromatous leprosy.
14/19

#healthcare
Arthritis secondary to immunologic reactions is symmetrical, affecting small joints of the hands and feet, leading to misdiagnosis as various rheumatologic disorders.
15/19

#internalmedicine
The patient’s overall clinical presentation, including increased pain and edema in his extremities, was felt to be consistent with immunologic reaction-associated arthritis and neuritis.
16/19

#primarycare
Management was aimed at controlling the inflammatory component of the disease using immunomodulation first followed by antimycobacterial therapy. (Fig, noted 3 months into treatment).
17/19

#dermtwitter significant improvement in ...
A diagnosis of leprosy should be suspected in a patient presenting with rash and biopsy findings positive for AFB with no growth on culture.
Molecular testing using a multilocus approach to mycobacteria can be used to confirm diagnosis.
18/19

#dermatología
Symptoms of worsening pain, edema, paralysis, and neuropathy in the extremities should additionally prompt concern for possible immunologic reaction to guide initiation of immunosuppressive regimen.
19/19

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revistainfectio.org/P_OJS/index.ph…
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El molusco contagioso:
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6 años♂️: dolor y alopecia en placas en cuero cabelludo de 3 meses de evolución; en las últimas 48 horas, fiebre y cefalea, adenopatías cervicales < 2 cm.
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@lauracatty95 @juliaserralabos @SeanPYeh @ContinuumAEP @aepediatria QUERION DE CELSO:
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#infecciosas #microbiología #micología
@lauracatty95 @juliaserralabos @SeanPYeh @ContinuumAEP @aepediatria ✔️Una o varias placas dolorosas con folículos y pústulas rodeadas de áreas de alopecia eritematosas; pueden evolucionar a abscesos.
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#AtencionPrimaria
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Jun 5, 2023
A 44-yo♂️, HIV +, CD4 cell count of 86/mL, viral load of 35,900 copies/mL: a 1-month history of fevers and pruritic blackish-brown lamellated plaques on the limbs and scalp.
¼
👇
DOI: 10.1056/NEJMicm2213894
#IDtwitter #dermatology Ming J. Liu, M.D., and Wei ...
A RPR titer of 1:32.
A Treponema pallidum particle agglutination: ➕.
A skin-biopsy of the left forearm 🔬: diffuse dermal lymphocytes and histiocytes admixed with a plasma-cell infiltrate.

MALIGNANT SYPHILIS
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#microbiology #dermpath #RareInfection
Malignant #syphilis:
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Human #intestinal #spirochetosis:
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🖊️A De Gea, @alfredomaldo ,@clarapath, @MarianaDazAlmi1, @alirri, Raquel Escudero, et al.
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#IntestinalSpirochetosis
Routine staining methods (haematoxylin & eosin & Warthin-Starry) can identify spirochetes on the surface of enterocytes.
Histologically, characteristic findings include a decrease in microvilli &a predominantly eosinophilic inflammatory infiltrate.
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#Pathologists #pathology Colonoscopic biopsy compare...
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Lactante, un mes de vida: fiebre, placa en la cara ligeramente sobreelevada, eritematosa, con coloración anaranjada periférica, delimitada, y con aumento de temperatura a la palpación
1/7

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#urgencias #microbiología
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Read 7 tweets

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