Background Herpes zoster (HZ) also known as shingles is a common dermatological pathology seen in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to immunocompromised individuals. However, it is rarely reported in the immunocompetent population. Case presentation We report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and an uncomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and influenza and was treated for both and discharged. He returned to the emergency department reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained, and he was discharged with a steroid topical cream. Fourteen days later, he returned to the clinic reporting crusting of the rash; the biopsy results were positive for herpes zoster. The diagnosis of multidermatomal herpes zoster was made, and he was then treated with antivirals. Conclusions Herpes zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation.
BackgroundMigraines are a commonly seen complaint in the emergency department, but migraines with extensive skin markings have rarely been reported and so the cause is still unknown.Case presentationWe report a 28-year-old Pakistani male complaining of recurrent migraines that are now associated with skin markings that appear on his forehead and last for a few days and then disappear on their own. A diagnosis of migraines with cutaneous markings was made. An MRI was done on the patient and showed normal results. The patient has only been given painkillers for the treatment of his migraines. No other treatment or interventions have been done.ConclusionThe cause of these markings is still unknown, and very little literature has been written on such cases. Those markings appear to be self-resolving as the migraines subside. More investigations and research have to be done in order to find the cause of such markings, establish the natural history, and enhance their management.
BackgroundOrbital cellulitis is a relatively uncommon presentation in the emergency department, but orbital cellulitis complicated by intracranial extensions, loss of vision, and death has rarely been reported in the literature.Case presentationWe report a 40-year-old Pakistani diabetic male complaining of 5 days of bilateral eye pain, proptosis, ophthalmoplegia, headache, and fever. A diagnosis of orbital cellulitis with intracranial extension was made. A computed tomography (CT) scan and a magnetic resonance imaging (MRI) were done on the patient and showed unremarkable orbits, extensive sinusitis, frontal abscess, and multiple septic emboli. The patient was admitted and on day 9 deteriorated and died.ConclusionOrbital cellulitis associated with intracranial extension is an extremely rare presentation, and the incidence is unknown. The use of contrast-enhanced imaging studies (CT/MRI) early on in the management of suspected orbital cellulitis is supported by the literature. Cerebritis and brain abscesses resulting from orbital cellulitis need advanced care from multidisciplinary teams. Further studies need to be done to provide recommendations on the use and benefit of surgical intervention.
Background: Cerebrospinal fluid rhinorrhea is a potentially life threatening condition and it is a rare emergency presentation. Most cases has been related to head trauma. However, CSF leak post COVID swab has been rarely reported.Case presentation: We report a 10 year old Emirati male, who presented to emergency department complaining of unilateral clear watery nasal discharge for 14 days, the discharge started after COVID-19 nasopharyngeal swab. The patient is a known case of 3MC syndrome and he underwent surgical repair for cleft lip and cleft palate. From the history and physical examination CSF rhinorrhea was highly suspected and nasal endoscopy confirmed the diagnosis of cribriform defect on the left side. The patient underwent surgical repair and his symptoms resolved after the surgery.Conclusion: We can conclude that COVID-19 nasopharyngeal swab has potential life threatening complications and one should consider the contraindications and the alternative methods available to detect COVID-19 to minimize the potential risks.
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