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.

Endoscopic evacuation of chronic subdural hematoma with rigid and flexible endoscope: case report

Introduction

Subdural haematoma (SDH) is a common neurosurgical condition after head trauma requiring evacuation to prevent secondary brain injury. The first choice of management in these patients is a large craniotomy or burr-hole evacuation. However, sometimes due to lack vision during drain tube insertion or irrigation the authors might land up in a complication like cortical bridging vein rupture, haemorrhage etc. Also, the management of septate chronic SDH (CSDH) with multiple neo-membranes does not have a well-defined surgical approach. Recently, endoscopic evacuation has been reported to a be a feasible method for evacuation in acute, subacute and chronic SDH patients.

Presentation of case

A 65-years-old male patient presented with a history of recent head injury and symptoms of headache and urinary incontinence of 7 days (Glasgow Coma Scale Score 15/15). Computed tomography scan revealed CSDH at both fronto-parietal convexity more on right side.

Discussion

The authors reported our initial experience on a typical case of an older patient with chronic subdural haematoma and its evacuation with the assistance of both rigid and flexible endoscope. The authors could visualize cortical bridging veins and neo-membranes intraoperatively and guided our drainage tube accordingly to avoid inadvertent haemorrhage. There was no recurrence of symptoms postoperatively. Thus we achieved apparent successful evacuation of the CSDH in this patient in a 6-month follow-up.

Conclusion

Endoscopic evacuation of CSDH proves to be an effective minimally invasive modality and more studies are required on larger patient groups with long-term follow-up imaging to confirm its superiority.

A young female of Cowden syndrome presenting with Lhermitte-Duclos disease: An illustrative case

Background

Lhermitte-Duclos Disease (LDD), or dysplastic gangliocytoma, which is a benign hamartomatous condition involving the cerebellum, has a possible association with Cowden syndrome (CS), a rare autosomal dominant disorder due to germline mutations in the phosphatase and tensin homolog (PTEN) tumor-suppressor gene in chromosome 10. Combined CS and LDD cases are rarely reported in the literature.

Case Description

We present here a case of a young female patient presented at the emergency department with a severe headache associated with vertigo, vomiting, and cerebellar ataxia. A magnetic resonance imaging scan revealed mixed intensity posterior fossa lesion with almost preserved cerebellar cortical striations. Her facial skin had extensive trichilemmoma. Her symptoms improved after the excision of the posterior fossa lesion through suboccipital craniotomy and histopathology revealed LDD.

Conclusion

In a low-resource country where genetic testing for neurosurgical condition is still inadequate, we used the validated Cleveland Clinic Adult Clinical Scoring for PTEN Testing and the patient had an 82-98% chance for a PTEN gene mutation. Finally, she along with her family was adequately counseled and was advised for regular screening and monitoring since it is a premalignant condition where early detection is imperative if any cancer arises in the near future and is now under our follow-up.

Recent incidence of infectious conjunctivitis in Bangladesh: Are we aware?

Bangladesh has seen a recent surge of infectious conjunctivitis nationwide for the last few weeks. Reported by journalists of daily newspapers, the incidence is now 33.33% in some eye outpatient departments (OPDs) of the country, which is surprisingly higher than the usual expected rate of the disease. In some districts, educational institutions have been shut down and it is greatly hampering the daily life of the citizens. Though the causative agent of the infection is yet unknown, the higher disease notification rate solicits rapid epidemiological studies and microbial assessment. Also, Bangladesh should be more aware in its hygiene practice and take adequate measures to halt the transmission of the disease to its South Asian neighbouring countries.

Optical Coherence Tomography: Basic Concepts and Applications in Neuroscience Research

Optical coherence tomography is a micrometer-scale imaging modality that permits label-free, cross-sectional imaging of biological tissue microstructure using tissue backscattering properties. After its invention in the 1990s, OCT is now being widely used in several branches of neuroscience as well as other fields of biomedical science. This review study reports an overview of OCT's applications in several branches or subbranches of neuroscience such as neuroimaging, neurology, neurosurgery, neuropathology, and neuroembryology. This study has briefly summarized the recent applications of OCT in neuroscience research, including a comparison, and provides a discussion of the remaining challenges and opportunities in addition to future directions. The chief aim of the review study is to draw the attention of a broad neuroscience community in order to maximize the applications of OCT in other branches of neuroscience too, and the study may also serve as a benchmark for future OCT-based neuroscience research. Despite some limitations, OCT proves to be a useful imaging tool in both basic and clinical neuroscience research.