Introduction Cetirizine hydrochloride is a second-generation H1 histamine antagonist with Food and Drug Administration approval for treatment of allergic rhinitis and urticaria. Currently, the Food and Drug Administration does not recommend use of cetirizine during breastfeeding, as there are insufficient studies on both the transference of cetirizine into human milk and the effects of cetirizine in infants. Main issue To determine the concentration of cetirizine in human milk, samples were analyzed using high performance liquid chromatography mass spectrometry. Management Based on calculations, relative infant dose was found to be 1.77% at 24 hr. In addition, there were no reported adverse effects seen in the infants. Conclusion We suggest that transfer of cetirizine into human milk is minimal and unlikely to pose a significant risk to the breastfeeding infant. This is the first report presenting the transfer of cetirizine in human milk.

Many cases of viral meningitis are idiopathic, but increased utilization of polymerase chain reaction testing has enabled physicians to better recognize rare causes of viral meningitis. This will likely continue to improve the rate of causative agent identification in seemingly idiopathic viral meningitis, including this case of human herpesvirus 6 (HHV-6) meningitis in an immunocompetent adult patient. More common viral etiologies need to be excluded before diagnosing HHV-6 meningitis, as this maximizes pretest probability and therefore increases validity of a positive result. By efficiently diagnosing HHV-6 meningitis, proper treatment protocols can be initiated earlier to reduce morbidity and mortality. Given the rarity of HHV-6 meningitis in immunocompetent adults, there are no established standard treatment guidelines; previous reported cases, as well as this case, suggest that either intravenous ganciclovir or intravenous foscarnet are the most reasonable first-line treatment options.

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The rise in incidence of e-cigarette or vaping product use associated lung injury (EVALI) and associated deaths has become a growing concern among public health officials. In most cases, the presenting and predominant complaints were respiratory in nature. However, in this case, the chief complaint was gastrointestinal symptoms. A 17-year-old male presented with a two-day history of sore throat, headache, and malaise followed by a one-day history of fever, vomiting, and diarrhea. Additional history revealed that patient was a regular user of THC vape cartridges. Computed tomography (CT) scan of the thorax showed a large right lower lobe consolidation with patchy infiltrates consistent with airspace pneumonia. He was later found to have C. difficile infection on day 3 and was started on metronidazole. After four days of ceftriaxone and supportive treatment, he showed significant improvement and was discharged on hospital day 5 with metronidazole and amoxicillin-clavulanate. In this case, the clinical picture of respiratory or gastrointestinal symptoms in the context of the patient’s using e-cigarettes or vaping products should bring EVALI into the differential diagnosis. Furthermore, this case highlights the need for increased public education regarding the dangers of e-cigarettes and vaping, especially with regard to increasing awareness among adolescent populations.  Keywords: vaping; EVALI; lung injury; public health; electronic THC delivery systems