We constructed a herpes simplex virus 2 (HSV-2) bacterial artificial chromosome (BAC) clone, bHSV2-BAC38, which contains full-length HSV-2 inserted into a BAC vector. Unlike previously reported HSV-2 BAC clones, the virus genome inserted into this BAC clone has no known gene disruptions. Virus derived from the BAC clone had a wild-type phenotype for growth in vitro and for acute infection, latency, and reactivation in mice. HVEM, expressed on epithelial cells and lymphocytes, and nectin-1, expressed on neurons and epithelial cells, are the two principal receptors used by HSV to enter cells. We used the HSV-2 BAC clone to construct an HSV-2 glycoprotein D mutant (HSV2-gD27) with point mutations in amino acids 215, 222, and 223, which are critical for the interaction of gD with nectin-1. HSV2-gD27 infected cells expressing HVEM, including a human epithelial cell line. However, the virus lost the ability to infect cells expressing only nectin-1, including neuronal cell lines, and did not infect ganglia in mice. Surprisingly, we found that HSV2-gD27 could not infect Vero cells unless we transduced the cells with a retrovirus expressing HVEM. High-level expression of HVEM in Vero cells also resulted in increased syncytia and enhanced cell-to-cell spread in cells infected with wild-type HSV-2. The inability of the HSV2-gD27 mutant to infect neuronal cells in vitro or sensory ganglia in mice after intramuscular inoculation suggests that this HSV-2 mutant might be an attractive candidate for a live attenuated HSV-2 vaccine.

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Abdominal pseudocysts are rare complications of ventriculoperitoneal (VP) shunts characterized by accumulations of cerebrospinal fluid surrounded by fibrous layers in the intra-abdominal cavity or abdominal wall. We present a woman with bilateral VP shunts who presented with right-sided abdominal distension, pain, and tenderness and who was found to have an abdominal pseudocyst on point-of-care ultrasound and computed tomography. Given the potential to develop a secondary infection or VP shunt malfunction, it is important for emergency providers to consider intra-abdominal complications of VP shunts, including rare ones such as abdominal pseudocysts, in these patients who present with vague abdominal complaints.

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Hematometrocolpos is a rare congenital abnormality of the female urogenital system that leads to an imperforate hymen and subsequent retrograde menstruation. We present the case of a 14-year-old female patient who presented to the emergency department with amenorrhea and abdominal pain, and was found to have an imperforate hymen and hematometrocolpos on trans-abdominal point-of-care ultrasound. It is important for emergency physicians to consider this diagnosis in pubescent female patients presenting with abdominal pain, as missed diagnosis can lead to infertility and other complications.

A 24-year-old woman presented to the Emergency Department with palpitations and watery emesis 2 hours after ingesting a cup of tea. The tea had been brewed from dried flowers that had been picked in a mountainous area of southern California. She had previously dissolved the flowers in oil and applied them topically to resolve bruises. She ingested the flowers in tea in an attempt to

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