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Background Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus. Case presentation A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery. Conclusion Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition

BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% vs 8.8%) (p=0.048) and the waist-hip ratio (0.98±0.07 vs 0.94±0.10) (p=0.006) was higher in males. Family history of hypertension was higher in females (24.1% vs 17.0%) (p=0.014). Most of the females were co-morbid with diabetes (37.9%) (p=0.008), hypertension (59.8%) (p<0.001) and dyslipidaemia (40.3%) (p<0.001) than males. The prevalence of smoking and alcohol intake was significantly higher in males (p<0.001). The predominant symptom was chest pain (93.4%), regardless of Sex. Right chest pain was primarily present in females (8.0% vs 3.6%) (p=048), and radiation of pain to the right arm mainly occurred in males (18.2% vs 7.5%) (p=0.007). Vomiting and dyspnoea was higher in females (47.7% vs 38.4%, p=0.049 and 53.1% vs 43.2%, p=0.039). The delay in presentation to the hospital was more in females (6:04±6:02) than males (3:55±4:22) with STEMI. The commonest reason for the delay was not suspecting an ACS, and a three-wheeler was the primary mode of transport in both sexes without any sex difference. Only 7.0% was delayed due to the unavailability of a transport facility.ConclusionFemale and male patients with ACS show differences in the age of onset, the spectrum of ACS, comorbidities, anthropometric measurements, risk factors like smoking and alcohol intake, clinical presentation aspects and delay in presentation to the hospital.

Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight loss. She had pale and had cervical lymphadenopathy, moderate hepatomegaly, and splenomegaly. Hb level was 9.2mg/dL, with a platelet count of 144 × 103/µL. The ESR was 65mm/hour, and the CRP level was 36 mg/L with a UPCR of 332mg/g. She had low C3, C4 levels, positive ANA, and dsDNA titer. A renal biopsy revealed class 3 lupus nephritis. Twenty days after, she was readmitted with acute onset of pleuritic chest pain, cough, and dyspnea, where she was hemodynamically unstable with SpO 2 of 85% on air. The Hb level was 8.6 g/dL with a platelet count of 106 × 103/µL. Her condition deteriorated despite standard medical care, where the Hb level and SpO 2 dropped to 5.6 d/dL and 65%, respectively, even after blood transfusions, intubation, and artificial ventilation. The chest X-ray revealed bilateral large whitish hazy shadows, and the HRCT scan revealed diffuse bilateral pulmonary hemorrhages. Then she was transferred to the ICU, and there she was started with broad-spectrum antibiotics, methylprednisolone, and plasmapheresis. However, after one week of ICU stay, her renal functions worsened, and she was initiated on CRRT. However, despite all the resuscitation efforts, she succumbed following a cardiac arrest. Conclusion: DAH is a rare catastrophic complication of SLE, which usually presents in patients with an established diagnosis of SLE, even on medical therapy. The diagnosis of DAH is problematic because it mimics a severe pulmonary infection. Early detection and aggressive management are warranted to improve affected patients' outcomes and quality of life.