Herpes zoster-encefalitis: een diagnostische uitdaging bij de geriatrische patiënt

Herpes zoster encephalitis: a diagnostic challenge in a geriatric patient Reactivation of the varicella zoster virus (VZV) is a prevalent disease and is - in addition to the typical vesicular rash - responsible for rare neurological conditions. Older people form a major group of concern, given the increasing risk of VZV reactivation at a higher age together with a higher risk of complications. Herpes zoster encephalitis is a rare but serious complication which often presents atypically, delaying the diagnostic process. In this article, the medical history of a patient with herpes encephalitis without the typical clinical and biochemical signs of infection is presented. This patient also suffered from Ramsay Hunt syndrome, another rare complication of VZV, characterized by vesicular rash in the ear and ipsilateral peripheral facial paralysis. Both diseases are briefly reviewed and the potential benefits of vaccination are discussed.

Ocular and Facial Herpes Zoster and Meningitis in an Adult after Zoster Vaccination

Purpose: To report a case of ocular and facial herpes zoster and meningitis after herpes zoster vaccination.Case summary: A 60-year-old man was administered Zostavax® on his left arm; he developed a vesicular rash over his left eye and forehead 4 days afterwards. He started antiviral drugs for the rash, and visited the hospital for severe headache and spread of the rash to involve the tip of his nose, face, and palate by day 7. He was taking Synthyroid® (Bukwang Pharmaceuticals, Seoul, Korea) since his thyroidectomy for thyroid cancer 6 years ago. He had never been diagnosed with chickenpox, but had an episode of red facial rash in childhood. Slit-lamp examination revealed conjunctival chemosis, hyperemia, and a pseudodendrite in the peripheral cornea. The anterior chamber was quiet, and there were no significant findings on his brain magnetic resonance imaging. Varicella zoster virus was detected in the cerebrospinal fluid by polymerase chain reaction. The patient was treated with oral acyclovir drugs and topical ganciclovir, levofloxacin, and bromfenac. One week later, the pseudodendrite disappeared and conjunctival chemosis improved. There was no recurrence during 6 months follow-up.Conclusions: Reactivation of ocular or facial herpes zoster or meningitis after zoster vaccination may occur, rarely. Immediate antiviral treatment is required in these cases.

ADAPTATION OF EARLY NEONATAL CHILDREN BORN FROM MOTHERS WHO REHIVED COVID-19 DURING PREGNANCY (DESCRIPTION OF TWO CASES)

The frequency of detection of infected children with SARS-CoV-2, which is 10% of the total number of infected, including newborns, suggests the need for careful diagnosis of pathological conditions that may occur in children, particularly in the neonatal period. If at the beginning of the detection of COVID-19 it was claimed that the coronavirus SARS-CoV-2 does not affect children, then analyzing the new data we see that 2% of patients with diagnosed clinical cases of COVID-19 are children, including newborns. The article describes observations of several clinical cases of early neonatal adaptation of children born to women who had mild to severe COVID-19 during the first and third trimesters of pregnancy, respectively, because these children at birth had vesicular rash, symptom, which is considered rare for this category of newborns. In 2020, 2,300 newborns were born in the neonatal department of the 3rd City Clinical Hospital of Lviv, with every 5th woman in labor (20%) relapsed to COVID-19 during pregnancy.Analyzing the course of early neonatal adaptation, we found that the adaptation period of such children may not differ from the adaptation of newborns in the number and manifestations of transient conditions characteristic of the first days of life, whose mothers did not suffer from COVID-19 during pregnancy. However, coronavirus infection in women in both the first and third trimesters of pregnancy may be associated with signs of congenital vesiculosis in children, accompanied by inflammatory changes in the blood and blood clotting in the period of early neonatal adaptation in the newborn. Children had no other signs of pathological symptoms (fever, lethargy, drowsiness, hypotension, rhinorrhea, pharyngitis, cough, respiratory disorders (tachypnea, wheezing), vomiting, diarrhea and feeding disorders)), characteristic of infectious diseases specific to newborns, which can be masked by transient states. Manifestations of transient conditions in the observed children were: milia, simple erythema, desquamative peeling of the epidermis, toxic erythema, physiological jaundice.Treatment of the affected areas of the skin with rash elements with 0.05% aqueous solution of chlorhexidine, a three-day course of ampicillin, administered to the child from the first hours of life at a dose of 100 mg / kg / day intravenously contributed to the disappearance of vesiculosis. The maintenance therapy was a multiprobiotic in the form of drops. In the presented cases, no obstacles to breastfeeding and cohabitation of mother and child were observed. In the departments of newborn maternity hospitals, it is necessary to find opportunities, for diagnostic purposes, to conduct microbiological studies of pustules and biomaterial from the mucous membranes of the genital tract to further compare the results and establish etiological factors of vesiculosis, determine biochemical blood tests - CRP, ALT, AST, LD serum, coagulation parameters.

Ramsay hunt syndrome- expect the unexpected: A case report

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.

Ramsay hunt syndrome- expect the unexpected: A case report

Herpes zoster represents a latent reactivation of the varicella zoster virus infection with a dermatomal pattern of eruption and complicated by post-herpetic neuralgia. Ramsay hunt syndrome is a rare complication of herpes zoster and it is not just a syndrome but it's rather an infectious disease. This syndrome is characterized by peripheral facial nerve palsy associated with an erythematous vesicular rash on the ear. It is characterized by unilateral pattern of facial involvement and presence of vesicles helps in early diagnosis and distinguish the syndrome with diseases mimicking other severe neurological diseases. This article reports a case of 56-year-old male patient who reported with a complaint of severe toothache, which serves as severe prodrome for reactivation of herpes zoster virus which later leads to Ramsay Hunt syndrome. This case report highlights about the management of herpes zoster and its complication and emphasizes on prevention of post herpetic neuralgia complication.

Herpes Zoster associated With COVID-19 in an immunocompetent male

Severe acute respiratory syndrome coronavirus (SARS-COV-2) presented with pulmonary symptoms and various extra pulmonary manifestations including dermatological manifestations like urticarial, acralvascular lesion erythematous maculopapular rash, and vesicular rash. Herpes zoster is a painful vesicular rash resulting from reactivation of varicella-zoster (VZ) virus that also a causative agent of chickenpox. The incidence of HZ infection (HZI) more prevalent in older ages and various immunosuppressive conditions. Coronavirus disease in 2019(Covid19) causing immune exhaustion and VZ virus reactivation, which is commonly presented as HZ in middle-aged adults. Here we report a case of HZ infection in association with COVID 19 positive 60 years male. Update Dent. Coll. j: 2021; 11(2): 35-37

Ramsay Hunt Syndrome: Viral Infection Coexisting with COVID-19

Severe acute respiratory syndrome coronavirus 2 presents with a multitude of different symptoms and signs, most described is respiratory compromise. Many viral and bacterial infections coexist with coronavirus disease 2019 (COVID-19). Many cranial neuropathies have also been reported, including facial nerve palsy and sudden sensorineural hearing loss individually. Ramsay Hunt Syndrome, which is conventionally described as acute peripheral facial neuropathy, associated with erythematous vesicular rash of pinna or external auditory canal can at times present with cochlear or vestibular symptoms along with it. We report the case of a 32-year-old male who presented with Ramsay Hunt syndrome with cochlear manifestation during his COVID-19 illness. Evaluation of the patient and further management have been described.

Fulminant varicella hepatitis: a rare but lethal cause of abdominal pain

An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.