Vesicular herpes zoster eruption following chronic obstructive pulmonary disease treatment in the emergency department: lessons learnt from immunosuppression.

Background: Herpes zoster (HZ) is a reactivation of the varicella-zoster virus (VZV) that can occur in people with weakened immune systems. Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that can also impair the immune system.6-8. Case presentation: The authors present the case of a 65-year-old male with COPD who developed HZ. The patient was initially admitted to the hospital for an acute exacerbation of COPD. After his condition stabilized, he developed vesicular rashes on the medial aspect of his left leg. A skin biopsy confirmed the diagnosis of HZ. Clinical discussion: This case report provides further evidence that HZ can be induced in patients who are undergoing treatment for COPD. The authors recommend that COPD patients be vaccinated against HZ to prevent this complication. Conclusion: HZ can develop in COPD patients, mainly using inhaled steroids. Compliance to medication should be monitored, on the other hand zoster vaccination should be provided to prevent it and its foremost complication which includes secondary bacterial infection, post-herpetic neuralgia, scarring, nerve palsy and encephalitis in case with disseminated zoster.

Anaphylactic shock following the mad honey consumption: a case report.

Introduction: Mad honey consumption is a common practice in Nepal for medicinal and consumption purposes, but it can lead to severe adverse effects. Grayanotoxin I and Grayanotoxin III isoforms found in rhododendron interfere with voltage-gated sodium channels resulting in gastrointestinal symptoms, and cardiovascular effects such as low blood pressure, abnormal heart rhythms, cardiac arrest, and abnormal electrical conduction in the heart, as well as rare central nervous system disorders. Here the authors report a case of Mad honey consumption leading to anaphylactic shock along with its investigations and management. Case presentation: The authors present a case of a 51-year-old female who developed anaphylactic shock after consuming mad honey. The patient experienced symptoms including nausea, vomiting, abdominal pain, sweating, dizziness, facial and lip swelling, but no chest pain, loss of consciousness, abnormal body movement, or dyspnoea. The patient had no prior medical conditions, regular medications, or history of allergic reactions to honey or pollen. Discussion: Mad honey intoxication is caused by grayanotoxins, with distinct cardiac effects for different types of grayanotoxins. Symptoms include bradycardia, hypotension, abdominal pain, dizziness, and nausea, which subsided within 24 h following the initial management. The presence of grayanotoxin can be detected using specialized instrumentation, but it may not be available in all medical facilities. Co-intoxication with alcohol or propolis may also occur. Conclusion: This case highlights the importance of recognizing and managing complications associated with mad honey consumption, particularly in regions where it is prevalent. Prompt medical attention is advised if unusual symptoms occur after honey consumption.

Intestinal tuberculosis can masquerade as Crohn's disease: A teachable moment.

Intestinal tuberculosis and Crohn's disease are chronic granulomatous diseases with similar clinical presentations and can mimic one another. Their treatment modalities are completely different; however, sometimes it is challenging to differentiate them. We report a case of a 51-year-old female presenting with abdominal pain and on-and-off diarrhea for 4 years with weight loss. Clinical symptoms along with multiple aphthous ulcers in the terminal ileum and negative tuberculin test favored the diagnosis of Crohn's disease. The patient did not respond to steroids. A repeat colonoscopy with acid-fast bacilli stain showed Mycobacterium tuberculosis. This case highlights that acid-fast bacilli culture and tuberculosis polymerase chain reaction to confirm or rule out the diagnosis of intestinal tuberculosis in all patients suspected of Crohn's disease.

Diesel siphoning induced chemical pneumonitis: a case report.

Diesel fuel aspiration can occasionally result in an uncommon but potentially deadly condition called chemical pneumonitis. Case presentation: In this case study, a 16-year-old boy gave a history of diesel fuel siphoning from a motor vehicle tank, which brought him to our emergency room. He complained of coughing, breathing difficulties, and chest discomfort upon admission to the hospital. Patchy bilateral parenchymal lung opacities consistent with acute chemical pneumonitis were seen in radiological imaging tests. Treatment included supportive care, oxygen supplementation, and intravenous antibiotics. The patient's symptoms improved gradually throughout his hospitalization, and he was eventually discharged home with a good prognosis. Clinical discussion: Siphoning is a common practice in developing countries like Bangladesh. Workers at automobile transfer hydrocarbon products from one vehicle to other. However, its aspiration can cause a pneumonia like features and may wrongly misdiagnose. Diagnosis is made mainly on history taking. Conclusion: Physicians ought to know that patients exposed to diesel fuel may develop chemical pneumonitis, and they should consider this for an early diagnosis and effective treatment that can lead to favourable outcomes.

Liver injury: the therapeutic dilemma of homeopathy - a case report from Bangladesh.

Despite the lack of scientific evidence supporting its effectiveness, homeopathic treatment is increasingly being used as a form of alternative medicine, with many people taking homeopathic remedies instead of drug therapies. It is based on the principle of 'like cures like', meaning that a remedy similar to the illness can be used to treat it. However, there have been several reports suggesting the risks of homeopathic remedies, among which homeopathy-induced liver injury is widely discussed. Here, we report a case of a 35-year-old well-oriented male patient with a typical clinical presentation of liver injury as presented by yellowish discoloration of sclera and skin along with generalized body itching following the use of homeopathic medicine for musculoskeletal pain. Laboratory reports of increased liver markers along with bilirubin were also suggestive. Excluding other differentials like viral hepatitis, alcoholic hepatitis, hemochromatosis, Wilson disease, and standard drug and toxin-induced hepatitis, the recent use of homeopathic remedies was a contributing factor in leading to the diagnosis of homeopathy-induced liver injury. He was then treated with the discontinuation of homeopathic medicine and supportive care. This case highlights the need for public awareness of the possible complications such as headache, tiredness, skin eruption, dizziness, bowel dysfunction, allergic reactions to acute pancreatitis, renal failure, neurological dysfunction, possible liver injury, and even mortality in those patients who pursue homeopathic treatments and health care professionals should take this into account when making a differential diagnosis in patients with liver injury.

Guillain-Barré syndrome following the second dose of COVID AstraZeneca vaccine in a 78-year-old male: a case report from Nepal.

Guillain-Barré syndrome (GBS) is a rare acute idiopathic demyelinating polyneuropathy that causes bilateral, symmetrical, and progressive weakness of muscles. AstraZeneca vaccine is a genetically modified spike glycoprotein vaccine of an adenovirus vector. GBS following the second dose of the AstraZeneca vaccine dose is rare and not frequently noted. Case Presentation: A 78-year-old male presented to the hospital with complaints of bilateral weakness of the lower limbs over 4 days following the second dose of the AstraZeneca vaccine. On examination, the power and tone of the limbs were diminished. The sensitivity pinprick test revealed low sensitivity in the right lower limb than in the left lower limb. Nerve conduction studies revealed acute inflammatory demyelinating polyneuropathy and the patient was diagnosed with GBS. After admission, the patient was successfully treated with intravenous immunoglobulins along with physiotherapy. Clinical Discussion: GBS can be diagnosed clinically with nerve conduction studies and Brighton's criteria. The robust causal relationships between COVID-19 infections, COVID-19 vaccination, and GBS are still unclear. The evaluation of the potential association and risk of GBS with vaccines warrants the need for precise post-vaccination surveillance measures and results. Conclusion: Only a few cases of GBS following the second dose of AstraZeneca are reported so far and there is a need for strong and accurate diagnosis of the disease and proper post-vaccination surveillance for the evaluation of risk associated with COVID vaccines.