Without a rash! A diagnostic dilemma for VZV vasculopathy

Varicella zoster virus vasculopathy is a condition that can classically present with a dermatomal zoster rash followed by a neurological deficit. The possible neurological manifestations and disease range are extensive. Diagnosis becomes more challenging in patients whose presentation does not include a rash, often causing cognitive errors and delay in treatment. We present a case of an 85-year-old patient, who developed stroke-like symptoms, initially with normal MRI, to later progress to multiple evolving enhancing lesions seen in subsequent MRIs. This case also represents the anchoring, that we as physicians can have when a patient with risk factors for stroke or TIA, presents to the emergency department complaining of unilateral weakness

Coccidioides immitis presenting with acute hydropneumothorax in an immunocompetent patient from South Texas

Coccidioidomycosis is a disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii that predominates in dry climates and it is endemic in Southern California and Arizona. Coccidioides is also found in parts of West Texas and a long the Rio Grande River, however, incidence tends to decrease in areas close to the Gulf of Mexico due to increased humidity. Coccidioidomycosis is more commonly a subclinical and self-limited disease in up to sixty percent of cases. Acute pneumonia (Valley fever), extra thoracic disseminated infection and complications occur more frequently in immunocompromised hosts. We present a case of severe coccidiomycosis in an immunocompetent host who lived in central California for two months, 2 years prior to manifesting severe respiratory compromise. Clinicians should be able to recognize differential diagnoses for cavitary-like lung lesions, paying close attention to social history and CDC epidemiology data