A Challenging Case of Idiopathic Hypereosinophilic Syndrome: An Itching in the Brain.

Hypereosinophilia (HE) has various causes and treatment remains a challenge when there is no relief to symptoms and a decrease in the eosinophil count. Such cases need extensive laboratory support, but the cause may remain obscured in some cases. This is a case of a 58-year-old known diabetic and hypothyroid female who initially presented with fever secondary to pyelonephritis and later developed severe itching and extensive skin hyperpigmented lesions. The laboratory findings were a persistently elevated eosinophil count and generalized itching that was refractory to treatment. The presentation of episodes of itching was like Gleich syndrome without angioedema and needed an injection of hydrocortisone and chlorpheniramine maleate to treat. Diethylcarbamazine, hydroxyurea, and steroids failed to decrease the eosinophilia as well as the episodic itching. We conducted an extensive workup for mutation studies. The bone marrow eosinophil count was above 20%. Considering it as idiopathic non-steroid-responding HE, imatinib was started, and the patient immediately responded, and the eosinophil count came within the normal range within one month. She has been followed up and closely monitored for the past 1 to 1.5 years with no relapse of symptoms and no rise in the eosinophil count.

A Study to Assess the Impact of Education on the Knowledge and Attitude Toward Cervical Cancer and HPV (Human Papillomavirus) Vaccination Among Female Healthcare Students.

Background Cervical cancer ranks among the top five cancers in India, with human papillomavirus (HPV) types 16 and 18 causing up to 70% of related lesions. HPV infection, acquired through various routes, poses risks for both men and women, especially in the age group of 16 to 25 years. Effective prevention is possible through HPV vaccination, with Cervarix and Gardasil approved for use in India. Despite its proven efficacy, HPV vaccine use remains minimal. This study aims to evaluate awareness, willingness, and barriers among female healthcare students while assessing the impact of a health education program on their knowledge and attitude. Methods The present study is an educational interventional study conducted on 489 female students in the healthcare sector in the age group of 19-25 years. Two questionnaires (pre-lecture and post-lecture) were used. After the pre-lecture questionnaire, a session on cervical cancer and vaccine education was delivered by the subject expert. Afterward, the post-lecture questionnaire was given and the impact of session was analyzed using various statistical tools. Result A total of 489 students across MBBS (Bachelor of Medicine, Bachelor of Surgery), BAMS (Bachelor of Ayurvedic Medicine and Surgery), BHMS (Bachelor of Homoeopathic Medicine and Surgery), paramedical, and nursing courses participated in the study. Prior to the lecture, knowledge regarding cervical cancer and vaccines was generally low across subgroups, witnessing improvements ranging from 60% to 100% in various questionnaire sections post-education. Understanding of the importance of a Pap smear (Papanicolaou test) increased significantly from 21% to 79% after the educational session. The most preferred measure to boost coverage was the inclusion of the HPV vaccine in the National Immunization Schedule, with lack of awareness identified as the most significant barrier. Conclusion An educational session not only enhances knowledge but also boosts willingness for cervical cancer vaccination. Inclusion of the vaccine in the National Immunization Schedule not only increases acceptability but also indirectly raises awareness.

A Case of Palmoplantar Keratoderma in the Constellation of Connective Tissue Diseases.

Overlap syndrome is a clinical challenge and brings together a wide range of treatment options for the treating physician. Addressing each and every complaint of the patient is crucial. A 50-year-old female patient presented with skin thickening, blackening, and hyperkeratosis; dysphagia; joint pain; features of myopathy; Raynaud's phenomenon; and dry mouth. Inflammatory markers were raised along with a positive antinuclear antibody (ANA) with Golgi apparatus pattern, anti-Sjögren's-syndrome-related antigen A (anti-SSA)/Ro60 3+, anti-SSA/Ro52 3+, and anti-PM/Scl 2+ antibodies that suggested overlap syndrome. Although the patient had no respiratory complaints, a unique interstitial lung disease (ILD) pattern was noted during the evaluation. Skin manifestations were puzzling, but the histopathology analyses of skin biopsies taken from two different sites revealed distinguishing features of cutaneous lupus and dermatomyositis. Treatment with hydroxychloroquine, pilocarpine, nifedipine, methotrexate, and topical tacrolimus produced a dramatic improvement in the clinical features. This case highlights subtle and florid features of different autoimmune diseases. The hyperkeratotic skin changes were the most striking feature, but the whole evaluation process unveiled many rare presentations of known autoimmune conditions that can open doors to new areas of our understanding toward connective tissue diseases (CTDs). Our case report demonstrates significant heterogeneity in the ANA patterns, ILD patterns, clinical manifestations, and treatment approaches.

Chronic Adult-Onset Still's Disease With Positive Antinuclear Antibodies: Navigating Diagnostic Dilemmas and Clinical Implications.

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by fever, rash, and joint pain. Despite primarily affecting young adults, it can occur at any age, presenting diagnostic challenges due to its heterogeneous nature and lack of specific laboratory findings. The subset of AOSD with positive antinuclear antibody (ANA) adds complexity, potentially overlapping with other autoimmune conditions. We describe a case of a 30-year-old female with a two-year history of fever, weight loss, and joint pain, initially misdiagnosed as seronegative arthritis with hypothyroidism. Further evaluation revealed severe anemia, leucocytosis, and hepatosplenomegaly. Despite a strongly positive ANA, the absence of systemic lupus erythematosus (SLE) features led to a diagnosis of chronic AOSD. Treatment with steroids and disease-modifying antirheumatic drugs (DMARDs) resulted in clinical improvement, highlighting the importance of accurate disease classification for tailored management in ANA-positive AOSD. This case underscores the diagnostic challenges of AOSD and emphasizes the need for precise classification for optimal treatment strategies.

Reactivation of Herpes Zoster Virus After COVID-19 Vaccination: Is There Any Association?

SARS-CoV-2 disease, COVID-19 infection, is a multi-system illness that has afflicted people all over the world. A number of vaccines have been produced to combat the current COVID-19 pandemic, and a variety of side effects have been recorded following the vaccination. However, there are limited data on the negative effects of immunological reactivation following vaccination. We report 10 incidences of herpes zoster reactivation within 7-21 days of getting the COVID-19 vaccination. Transient immunomodulation following vaccination, similar to that seen in COVID-19 illness, could be one explanation for this reactivation. These cases highlight the significance of continuing to examine vaccine safety during the COVID-19 pandemic's ongoing mass vaccination campaign. We also underline the importance of peripheral health professionals in the management and reporting of any vaccination-associated adverse event.