Since early 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of individuals and changed the face of medicine. As the fight against COVID continues, there is still unclear long term effects; although as time passes, more and more is being updated, in regards to the risks of exposure, length of recovery, outcomes of those infected, effectiveness of vaccines, and both expected and unique side effects of both the virus and vaccines, all in an array of individuals. This paper will review a unique topic of the SARS-CoV-2 virus and the abnormal immune response in a young patient. This case is unique due to the fact that there have been an abundance of side effects reported that are associated with the virus that affects every organ system, yet very few have affected the neurological and integumentary (skin) system. This case emphasizes the reactivation of a Herpes/Varicella-Zoster virus (VZV) in a young male shortly after he received the Pfizer-BioNTech COVID-19 vaccine. The other interesting aspect about this case is the patient’s immunocompromised state, as he was diagnosed with HIV several years before this viral reactivation occurred. The interesting aspect about this was trying to understand whether the VZV was truly reactivated because of an overly stressful immune reaction in response to the Pfizer-BioNTech COVID-19 vaccine or was it mainly due to the patient’s already weak immune system, or even a combination of both? The in-depth review will evaluate whether there should be more done in regards to bringing more awareness about potential side effects and preparing for a VZV reactivation and/or other dermatological complications after being vaccinated. This presentation could also simply be a very unique, isolated case, and that each individual should have no hesitations regarding the Pfizer-BioNTech COVID-19 vaccine.

all at affiliation 2); Miles W. Carroll (at affiliation 7); and Annina Schmid (at affiliation 9). Also, two author names (Rachel Varughes and Gary Mallett) were incorrect; the correct names are 'Rachel Varughese' and 'Garry Mallett' (respectively). The errors have been corrected in the HTML and PDF versions of the article.

Hyperacute cardio-cerebral Infarction with simultaneous acute myocardial infarction and acute ischemic stroke (2), is an extremely rare and deadly condition with management dilemma. To date, there were no clear consensus guideline in terms of managing this group of patients. Herein, we are presenting a challenging case of hyperacute cardio-cerebral infarction as well as its diagnostic and management dilemma. CASE PRESENTATION:A 77-year-old gentleman with no known past medical history was brought to the hospital for altered mental status, slurred speech and right sided weakness that started acutely when the patient woke up. According to the patient's daughter, patient also complained of chest tightness and dyspnea on exertion, progressively worsening for the past 3-days. Initial vital signs showed a temperature 98.9, heart rate 126, respiratory rate 25 and oxygen saturation 89%. Pulmonary exam decreased air entry to the lungs bilaterally with diffuse crackles heard. Cardiovascular exam showed tachycardia, regular and normal heart rhythm with no murmurs. Neurological examination was significant for right sided weakness with muscle strength 3/5 on upper and lower right extremity with hyper-tonic and hyper-reflexia. Electrocardiogram displayed inferolateral ST elevations with an elevated troponin of 93. Code STEMI was called. Patient was intubated in light of GCS < 8 with incapable of protecting his own airway. In light of neurological signs on physical examination, computed tomography (CT) of the head was ordered which showed acute to subacute infarct at left middle cerebral artery territory with possible hemorrhagic conversion. CT angiogram of the chest otherwise ruled out aortic dissection. Patient was placed on mechanical ventilation for ventilatory support and in light of the possible hemorrhagic conversion, antiplatelets and anticoagulation were held. Cardiac catheterization was also not possible in light of ischemic stroke with hemorrhagic conversion which limit the use of antiplatelets. Patient was on mechanical ventilation for 21 days and ultimately expired due to cardiorespiratory arrest secondary to ventricular arrythmia. DISCUSSION:The purpose of this case is to examine and understand the potential benefits of implementing future guidelines for cases of hyperactive cardio-cerebral Infraction. Although very rare, the potential benefits of having a clear understanding of which pathology to treat first, by implementing proper guidelines, would help to further understand both pathologies, prevent severe complications and to reduce the morbidity and mortality.CONCLUSIONS: Whether to treat the brain and heart first is always a challenging management dilemma, in this case, if the patient has no acute contraindication for antiplatelets/anticoagulation, patient may benefit from cardiac catherization after 48 hours of stabilization of acute stroke.