Varicella bullosa a rare form of chickenpox in an immunocompromised child: a case study

The common human alpha herpesvirus known as varicella-zoster virus (VZV) causes both varicella (chicken pox) and herpes zoster (shingles). The frequent paediatric illness varicella is characterized by fever, viremia, and sporadic vesicular skin lesions. The bullous onset of chickenpox, is a very uncommon symptom that typically affects children who are immunosuppressed. Modern methods, such as polymerase chain reaction (PCR), have shed new light on this issue and strongly suggest that VZV can be involved in the development of bullae. Adequate prophylaxis and vaccination coverage help high-risk populations avoid complications. A7-year-old girl with polymorphic rash all over the body with comorbid diseases, diabetes mellitus type 1 and celiac disease. Past medical history stated suffering from COVID-19 infection. Physical examination revealed vesicular rashes of healing stages on various parts of the body with intense itching along with other symptoms of weakness, lethargy and lack of appetite. Based on the history, physical exam, and laboratory investigations, a definitive diagnosis of uncomplicated chickenpox, bullous form of moderate severity, was made. Treatment with saline infusion, iodinol, brilliant green solution, loratadine, acyclovir, amoklav, topical levofloxacin, and topical noxivin was initiated. The outcomes demonstrated that immunosuppression, autoimmune diseases and unvaccinated state of immunity might be the predisposing factors for development of bullous varicella. Inspite of its rarity, the disease have a good prognosis.

Undifferentiated necrotizing ulcerative vasculitis in a patient with pneumonia and stage 5 chronic kidney disease-a case report

Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well.

A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study

Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.

Undifferentiated necrotizing ulcerative vasculitis in a patient with pneumonia and stage 5 chronic kidney disease-a case report

Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well.

A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study

Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.