Anti-NMDAr Encephalitis and COVID-19 in a Patient With Systemic pANCA-Vasculitis and Recurrent Varicella Zoster Infection

Introduction There is a complex interplay between systemic autoimmunity, immunosuppression, and infections. Any or all of these can result in neurologic manifestations, requiring diligence on the part of neurologists. Case report We herein report a case of a patient on immunosuppressive treatment for a vasculitis that resulted in zoster meningoencephalitis. This was further complicated by the development of anti-NMDAr encephalitis, the etiology of which is undetermined and further discussed in this paper. The patient eventually developed COVID-19 during hospitalization, succumbing to the respiratory infection. Conclusion This case emphasizes that post-infectious autoimmune disorders are becoming increasingly recognized and that they should still be considered in patients who are on immunosuppression. Practitioners should be aware of the complex relationship between autoimmunity and immunosuppression and consider both throughout the disease course.

Reactivation of varicella zoster infection presenting as acute retinal necrosis post COVID 19 vaccination in an Asian Indian male

Purpose: To present the clinical features of a rare case of varicella zoster infection following one dose of Coronavirus Disease 2019 (COVID-19) vaccination in an elderly Asian Indian male. Methods: Retrospective observational case report. Results: A 71-year-old gentleman presented to us with complaints of reduced vision associated with redness and pain in his right eye for 1 week. On examination he revealed a right eye pan uveitis picture with circumcorneal congestion, multiple fine keratic precipitates, anterior chamber cells and flare, vitritis and widespread areas of acute retinal necrosis. His left eye was within normal limits. Ten days prior to the presentation he had received the first dose of COVID-19 vaccine following which he had developed fever for 2 days that preceded the red eye. The patient’s aqueous sample tested positive for varicella zoster virus (VZV) by nested polymerase chain reaction (PCR) method. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reverse transcriptase polymerase chain reaction (RT-PCR) assay from the aqueous and also from the nasopharyngeal swab was negative. Conclusion and significance: To the best of our knowledge this is the earliest description of a case that has a viral reactivation following COVID-19 vaccination. Elderly people with pre-existing comorbidities, may be at a risk of both primary coronavirus infection and unconceivable risk of aberrant immune reactions leading to a different virus infection or reactivation need to be kept in mind. We present a possible link between SARS-CoV-2 virus vaccination and varicella zoster reactivation in this patient.

Herpes Zoster Anterior Uveitis with Hyphaema

Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.

Complications of Chickenpox in Bulgaria – Data from a Single-Center Experience

Primary Varicella zoster infection (chickenpox) in childhood is a common benign disease. The predominance of uncomplicated cases in children often overshadows the rarer cases of complicated severe course of the disease. Objective To study the complications of primary chickenpox in hospitalized patients for a period of one year. Materials and Methods 122 patients with complicated primary chickenpox with an average age of 18.6 years; 57 males (46.7%) and 64 females (53.3%), were hospitalized at the University Hospital of Infectious and Parasitic Diseases “Prof. Iv. Kirov” in the period January – December 2019. Results The bacterial infections of the skin and soft tissues comprised the largest relative frequenchy – they occurred in 74 (60.6%) of the patients; followed by pneumonia – in 31 (25.4%) patients, and a combination of pneumonia and pustulation – in 10 (8.2%) patients. Cerebelitis was observed in 1 (0.8%) patient. One of the patients developed hepatitis, purulent arthritis and acute enteritis. We also report the death of one patient. Conclusions We registered a relatively high proportion of hospitalizations, especially in young children and adults. Regarding the type of complications, we do not describe significant differences compared to other authors. Although in most cases primary chickenpox is a self-limiting disease, complications are more common in the countries where there is no vaccine.

A Case Report on Congenital Adrenal Hyperplasia, Varicella Zoster Infection, Varicella Encephalopathy & Cerebellitis

Congenital adrenal hyperplasia (CAH) comprises a family of autosomal recessive disorder and it will disrupt adrenal steroidogenesis. The most common form of CAH is due to 21-hydroxylase deficiency associated with mutations in the cyp21a2 gene which is located at chromosome 6p21. The clinical features associated with this adrenal steroidogenesis represent a clinical spectrum reflecting to the consequences of the specific mutations. Treatment goals include normal linear growth velocity and “on-time” puberty in affected children. [1] Infection with Varicella zoster virus (vzv) causes chickenpox means Varicella that can be severe in immunocompromised individuals, infants and adults. The primary infection is followed by latency in ganglionic neurons. During this time, no virus particles will produce and no obvious neuronal damage occurs. Reactivation of virus leads to virus replication, which will causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death [2]. Potential complications of this infection are involved in the central nervous system causing encephalitis. An increased risk of this complication is associated with the immunocompromised patient. [3] Keywords: congenital adrenal hyperplasia, varicella zoster infection, varicella encephalopathy, cerebellitis.

Patients with non-idiopathic sudden sensorineural hearing loss show hearing improvement more often than patients with idiopathic sudden sensorineural hearing loss

IntroductionTo compare inpatient treated patients with idiopathic (ISSNHL) and non-idiopathic sudden sensorineural hearing loss (NISSNHL) regarding frequency, hearing loss, treatment and outcome.MethodsAll 574 inpatient patients (51% male, median age: 60 years) with ISSNHL and NISSNHL, who were treated in federal state Thuringia in 2011 and 2012, were included retrospectively. Univariate and multivariate statistical analyses were performed.ResultsISSNHL was diagnosed in 490 patients (85%), NISSNHL in 84 patients (15%). 49% of these cases had hearing loss due to acute otitis media, 37% through varicella-zoster infection or Lyme disease, 10% through Menière disease and 7% due to other reasons. Patients with ISSNHL and NISSNHL showed no difference between age, gender, side of hearing loss, presence of tinnitus or vertigo and their comorbidities. 45% of patients with ISSNHL and 62% with NISSNHL had an outpatient treatment prior to inpatient treatment (p < 0.001). The mean interval between onset of hearing loss to inpatient treatment was shorter in ISSNHL (7.7 days) than in NISSNHL (8.9 days;p = 0.02). The initial hearing loss of the three most affected frequencies in pure-tone average (3PTAmax) scaled 72.9 dBHL ± 31.3 dBHL in ISSNHL and 67.4 dBHL ± 30.5 dBHL in NISSNHL. In the case of acute otitis media, 3PTAmax (59.7 dBHL ± 24.6 dBHL) was lower than in the case of varicella-zoster infection or Lyme disease (80.11 dBHL ± 34.19 dBHL;p = 0.015). Mean absolute hearing gain (Δ3PTAmaxabs) was 8.1 dB ± 18.8 dB in patients with ISSNHL, and not different in NISSNHL patients with 10.2 dB ± 17.6 dB. A Δ3PTAmaxabs ≥ 10 dB was reached in 34.3% of the patients with ISSNHL and to a significantly higher rate of 48.8% in NISSNHL patients (p = 0.011).ConclusionsISSNHL and NISSNHL show no relevant baseline differences. ISSNHL tends to have a higher initial hearing loss. NISSHNL shows a better outcome than ISSNHL.