No abstract

In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.

The COVID-19 epidemic had an enormous effect on the health of millions of individuals worldwide and the global economy. A shortage of doctors, nurses, personal protective equipment, and medicines was seen globally. The pandemic drew attention to limitations in the healthcare sector of the United States of America. The massive rise in the daily number of cases, more usage of ICU facilities and all the treatment modalities, and increased overtime compensation for the staff negatively impacted the hospital’s finances. This also affected the mental and physical health of all the healthcare workers. Through additional funding from federal relief legislation and the relaxation of many regulatory requirements, the federal, state, and local governments took significant steps to address the need for prevention and treatment services that arose from COVID-19 and the disruptions in healthcare delivery and finances resulting from the pandemic. Congress enacted the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, on March 27th, 2020. This measure appropriated $2.2 trillion to offer immediate and direct economic assistance to Americans affected by the COVID-19 outbreak.