Facial nerve palsy: An early sign of COVID-19.

Introduction: Bell's palsy is a peripheral lower motor neuron (LMN) facial nerve palsy, characterized by the acute onset (72 hours or less) of unilateral peripheral facial paresis without other neurologic signs. Bell's palsy has been described at three clinical junctures of COVID-19 infection: as the unique initial signal of COVID-19, as an accompanying feature during the acute phase of COVID-19 when respiratory and systemic symptoms predominate, or during the recuperative phase beginning 2-3 weeks after resolution of respiratory and systemic covid symptoms. Case report: We present a unique case of a COVID-19-related facial nerve palsy that occurred 3 weeks prior to the onset of pneumonia caused by COVID-19. Conclusions: This case report suggests an association between early COVID-19 presenting as facial nerve palsy and alerts physicians about the ways in which COVID-19 may cause this phenomenon.

A rare presentation of infectious mononucleosis: cholestatic hepatitis with hyperbilirubinemia.

Introduction: Epstein-Barr virus infection with mononucleosis is the most common presentation in young adults. Most infections are self-limited, although in a few cases complications can include serious conditions such as lymphoproliferative disorders or in less severe cases, mild hepatitis. Case report: We present an unusual case of a young male with no liver disease, who presented with markedly elevated cholestatic pattern hyperbilirubinemia, as well as hepatitis. The patient responded well to symptomatic treatments, with spontaneous improvement of the hyperbilirubinemia and transaminitis. Conclusions: Epstein-Barr virus mononucleosis can frequently present with mild elevation of transaminases, but very rarely can have marked elevation of bilirubin, which may make clinicians doubt that the infection is the sole culprit of the process.

Unusual Case of Non-HIV Patient With Multifocal Pyomyositis: Developed on Appropriate Antibiotic Therapy.

Pyomyositis is a clinical condition classically associated with tropical climates, but there are an increasing number of reports in temperate climates. We present a diabetic patient, who presented with gastrointestinal symptoms and right foot ulcer. He was found to have methicillin-resistant Staphylococcus aureus (MRSA). Initial computed tomography (CT) scan of abdomen and pelvis was negative for any abscesses, but after persistent bacteremia developed pyomyositis being on appropriate antibiotic therapy. This case may make physicians aware that initial negative test results do not always preclude the presence of pyomyositis in the presence of risk factors.

Acute Hepatitis due to Garcinia Cambogia Extract, an Herbal Weight Loss Supplement.

The Drug Induced Liver Injury Network reports dietary supplements as one of the most important causes of drug induced hepatotoxicity, yet millions of people use these supplements without being aware of their potential life-threatening side effects. Garcinia cambogia (GC) extract is an herbal weight loss supplement, reported to cause fulminant hepatic failure. We present a case of a 57-year-old female with no previous history of liver disease, who presented with acute hepatitis due to GC extract taken for weight loss, which resolved after stopping it and got reaggravated on retaking it. Obtaining a history of herbal supplement use is critical in the evaluation of acute hepatitis.