An adult with hemorrhagic varicella co-infects with cytomegalovirus: a case report.

BACKGROUND: Hemorrhagic varicella (HV) is a particular form of chicken pox.,with high mortality in adults. This form of the disease is rare, to date, approximately 4 cases have been reported. Occasional cases of HV have been documented in adults with hematologic disorders or other diseases. While there is one reported case of simultaneous reactivation of cytomegalovirus in an adult with chickenpox, there is a lack of information regarding changes in liver function indicators for such patients. This is unfortunate, as CMV reactivation can further exacerbate liver failure and increase mortality. In this report, we present a case of hemorrhagic varicella reactivation with cytomegalovirus and provide some relevant discussions. CASE PRESENTATION: We present the case of a 25-year-old male with HV, who had a history of nephrotic syndrome generally controlled with orally administered prednisone at a dosage of 50 mg per day for two months. The patient arrived at the emergency room with complaints of abdominal pain and the presence of hemorrhagic vesicles on his body for the past 3 days. Despite medical evaluation, a clear diagnosis was not immediately determined. Upon admission, the leukocyte count was recorded as 20.96 × 109/L on the first day, leading to the initiation of broad-spectrum antibiotic treatment. Despite the general interpretation that a positive IgG and a negative IgM indicate a previous infection, the patient's extraordinarily elevated IgG levels, coupled with a markedly increased CMV DNA quantification, prompted us to suspect a reactivation of the CMV virus. In light of these findings, we opted for the intravenous administration of ganciclovir as part of the treatment strategy. Unfortunately,,the patient succumbed to rapidly worsening symptoms and passed away. Within one week of the patient's demise, chickenpox gradually developed in the medical staff who had been in contact with him. In such instances, we speculate that the patient's diagnosis should be classified as a rare case of hemorrhagic varicella. CONCLUSION: Swift identification and timely administration of suitable treatment for adult HV are imperative to enhance prognosis.

Endogenous n-3 polyunsaturated fatty acids protect against imiquimod-induced psoriasis-like inflammation via the IL-17/IL-23 axis.

The beneficial effects of n-3 polyunsaturated fatty acids (PUFAs) on psoriasis have been reported in rats, mice and humans, but the specific mechanisms involved have not been well defined. The present study utilized the fat-1 mouse, a transgenic model that can endogenously convert n-6 FAs into n-3 PUFAs, to directly determine if the outcomes of psoriasis were correlated with n-3 PUFAs. Wild-type (WT) and fat-1 mice, which were treated daily with imiquimod (IMQ) cream or control cream on the shaved right ear and dorsal skin, were fed the same diet. The severity of inflammation of the ear and dorsal skin was scored according to the clinical Psoriasis Area and Severity Index (PASI) and epidermal hyperplasia was measured by H&E staining. The expression of inflammatory factors in the epidermis was analyzed by immunohistochemical analysis. Flow cytometry and an enzyme-linked immunosorbent assay were used to measure the differences in the content of inflammatory factors in the blood serum and to determine which of CD4+ T cells were present in the spleen between IMQ-induced fat-1 mice and WT mice. Fat-1 IMQ-induced mice exhibited significantly lower levels of inflammatory cell-like T helper 17 cells (Th17 cells) and higher levels of regulatory T cells (Treg cells) in the spleen as compared with the WT IMQ-induced mice. n-3 fatty acids stimulated Th17 cells to produce lower levels of inflammatory factors, including interleukin (IL)-17, IL-22, IL-23 and stimulated Treg cells to produce higher anti-inflammatory factors, such as Foxp3. In conclusion, the present study provides further insight into the mechanisms involved in preventing inflammation in psoriasis-like mice by n-3 PUFAs using a fat-1 transgenic mouse model.