Successful oral treatment of third cranial nerve palsy and optic neuritis from neglected herpes zoster in an immunocompetent patient

Bioinformatic analyses suggest augmented interleukin-17 signaling as the mechanism of COVID-19-associated herpes zoster

Herpes zoster results from latent varicella zoster virus reactivation in the dorsal root ganglia, causing blistering rash along the dermatomal distribution and post-herpetic neuralgia. Increasing studies indicated that there may be a correlation between herpes zoster and COVID-19. Nevertheless, the detailed pathophysiological mechanism is still unclear. We used bioinformatic analyses to study the potential genetic crosstalk between herpes zoster and COVID-19. COVID-19 and herpes zoster were associated with a similar subset of genes involved in "cytokine-cytokine receptor interaction," "Jak-STAT signaling pathway," and "IL-17 signaling pathway," including TNF, IL10, ESR1, INFG, HLA-A, CRP, STAT3, IL6, IL7, and IL17A. Protein-protein interaction network assay showed that the combined gene set indicated a raised connectivity as compared to herpes zoster or COVID-19 alone, particularly the potentiated interactions with APOE, ARSA, CCR2, CCR5, CXCL13, EGFR, GAL, GP2, HLA-B, HLA-DRB1, IL5, TECTA, and THBS1, and these genes are related to "cytokine-cytokine receptor interaction". Augmented Th17 cell differentiation and the resulting enhanced IL-17 signaling were identified in both COVID-19 and herpes zoster. Our data suggested aberrant interleukin-17 signaling as one possible mechanism through which COVID-19 could raise the risk of herpes zoster.

Unilateral Pupil Sparing: Viral Oculomotor Neuritis With Concomitant Vestibular Neuritis

Unilateral oculomotor nerve palsy is a common clinical condition with various etiologies, including aneurysm, diabetes mellitus, central nervous system (CNS) infections, pituitary tumors, and ischemic changes. Due to the plethora of possible causes, early and thorough investigation is essential for treatment. We report the case of a 45-year-old male who presented with left ptosis, vertigo, and blurry vision and was diagnosed with oculomotor neuritis. Past medical history (PMH) was significant for hyperlipidemia, diabetes, and chronic kidney disease. Patient imaging revealed chronic left cerebellar infarction but no acute changes. Significantly, he was experiencing intractable nausea, dizziness, and vomiting attributed to concomitant vestibular neuritis. Infectious etiologies of oculomotor neuritis are rarely reported. However, idiopathic vestibular and facial palsies are commonly attributed to viral infection. The patient was treated with a steroid taper for viral vestibular neuritis, with noticeable clinical improvement to his oculomotor neuritis manifestations. This postulates a common viral etiology uniquely causing both oculomotor and vestibular neuritis.

Severe Bilateral Photophobia and Unilateral Abducens Nerve Palsy: An Unusual Presentation of Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus (HZO) is an uncommon neurocutaneous condition resulting from reactivation of the varicella zoster virus in the ophthalmic division of the trigeminal nerve. Typical presentation of HZO includes a characteristic painful vesicular dermatomal rash. However, the appearance of isolated neurologic complications in the absence of ocular findings has not been previously emphasized. We observed a 47-year-old female patient with established HZO who presented with 1 week of worsening bilateral photophobia and double vision following completion of antiviral treatment. Her motility examination revealed near-complete abduction deficit of her left eye with no other signs of neurologic deficit. Slit lamp biomicroscopy, magnetic resonance imaging, and all laboratory tests were negative. After 2 tapering cycles of oral corticosteroid treatment, her photophobia resolved, and ophthalmoplegia significantly improved. The failure of antiviral therapy in preventing our patient's neurologic sequelae highlights the importance of concurrent steroid therapy in suspected HZO patients. Furthermore, the resolution of symptoms following administration of systemic glucocorticoids supports consideration of HZO complications as immune-mediated. Finally, the unusual presentation of bilateral photophobia in the absence of ocular inflammation warrants further investigation into the pathogenesis of HZO.

Screening and application of a broad-spectrum aptamer for acyclic guanosine analogues

Acyclic guanosine analogues, a class of widely used antiviral drugs, can cause chronic toxicity and virus resistance. Therefore, it is essential to establish rapid and accurate methods to detect acyclic guanosine analogues. In this study, five acyclic guanosine analogues (acyclovir, famciclovir, ganciclovir, penciclovir, and valaciclovir) were used as positive targets to obtain broad-spectrum aptamers through Capture-SELEX technology. Real-time quantitative PCR (Q-PCR) was used to monitor the aptamer SELEX process. After the sixteen rounds of selection against mixed targets, sequences were obtained by high-throughput sequencing (HTS). Furthermore, a broad-spectrum aptamer, named CIV6, was found as the higher performance aptamer that was suitable for five acyclic guanosine analogues by graphene oxide (GO) polarization and fluorescence assay. Finally, the aptamer CIV6 was used to construct GO fluorescence assay to detect five acyclic guanosine analogues. The limits of detection (LOD) of acyclovir, famciclovir, ganciclovir, penciclovir, and valaciclovir were 0.48 ng·mL^-1, 0.53 ng·mL^-1, 0.50 ng·mL^-1, 0.56 ng·mL^-1, and 0.38 ng·mL^-1, respectively.