Varicella-zoster virus is a neurotropic virus that after the primary infection, usually manifested as chickenpox, may reactivate with infection of the central nervous system. When no skin lesions are present, a high clinical suspicion is required to reach the diagnosis. We report a case of an adolescent boy with varicella-zoster virus reactivation with meningitis in the absence of a zoster rash. Case ReportA 15-year-old boy was admitted to the emergency room with a nine-day history of persistent frontal headache. The headaches responded poorly to analgesia but had no other alarming features. Two days prior to admission, he complained of nausea, vomiting and hypersensitivity to light and loud noises. He had no fever, rash, or additional symptoms. DiscussionVaricella-zoster virus (VZV) is a neurotropic virus that

Introduction: Inhalers are recommended for asthma prophylactic and crisis therapy. In order to have a good deposition of drugs at pulmonary tissue, the correct use of the devices is necessary.Objective: To verify the inhaler use technique with pressurized metered-dose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs) in a pediatric sample (ages between 1 and 17 years old).Material and Methods: Descriptive, observational and cross-sectional study. Application of a checklist that included the steps of the correct inhaler use technique, which was performed under physician observation, and other questions related to the use of the devices. Results:We observed a total of 83 inhaler use techniques: 46 pMDIs with spacers and 37 DPIs. About 54% of pMDIs with spacers users and 27% of DPIs users performed the inhaler use technique correctly, p=0.012. The most frequent mistakes in pMDIs with spacers users were: 50% didn't waste the first puff, 17.4% didn't shake the device prior to use and 28.3% didn't wait between inhalations. The mistakes observed in DPIs users were: 43.2% didn't perform a forced expiration before inhaler use, 13.5% didn't start with a forced inspiration, 24.3% didn't pause at the end of inspiration, 32.4% didn't exhale slowly and 35.1% didn´t wait between inhalations. Conclusion:Multiple mistakes were observed even in the users who had been followed up for several years. The most frequent mistakes occurred in DPIs users. Thus, the inhaler use technique must always be observed by the physician in all appointments, especially in users of DPIs in which the correct use depends on their autonomy.