American Journal of Emergency Medicine最新文献

{"title":"An analysis of NIH research funding in emergency medicine","authors":"Priscilla Mejia MS ,&nbsp;James J. Menegazzi PhD","doi":"10.1016/j.ajem.2025.09.023","DOIUrl":"10.1016/j.ajem.2025.09.023","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was threefold. We sought to: 1) determine the total dollar amount of National Institutes of Health (NIH) funding received by Emergency Medicine (EM) researchers; 2) determine the relative proportion and ranking of monies awarded compared to the total; and 3) to compare NIH funding received by EM to the select specialties of Neurology, Anesthesiology, Surgery, Orthopedics, and Obstetrics-Gynecology (OBGYN) for the years 2006–2024.</div></div><div><h3>Methods</h3><div>We performed a repeated cross-sectional analysis of NIH funding garnered by the Blue Ridge Institute for Medical Research (BRIMR) from the publicly available NIH RePORTER database. The BRIMR has tabulated data on the amount of NIH funding awarded to medical specialties and biomedical sciences received from 2006 to 2024, as well as their respective rankings for each year. Total dollar amount awarded to EM, Neurology, Anesthesiology, Surgery, Orthopedics, and OB/GYN and their relative rankings were identified, as was the proportion of total monies awarded by year.</div></div><div><h3>Results</h3><div>EM ranked last in funding compared to all specialties in 2006, 2007, and 2008 and climbed to 47th percentile by 2024. Every year, less than 1 % of funding was awarded to EM, whereas neurology was awarded 3.40 %–5.71 %. Compared to Neurology, Anesthesiology, Surgery, Orthopedics, and OB/GYN, EM ranked the lowest in total funding in all years except 2023 and 2024 in which only orthopedics ranked lower. Not included in our analysis is Internal Medicine, who received the most funding every single year, and was awarded $5.3 billion in 2024 while EM was awarded $159 million in 2024.</div></div><div><h3>Conclusion</h3><div>NIH funding varies substantially between specialties. EM has consistently experienced very low NIH funding (never exceeding 1 % of total) compared to other specialties with which they commonly interact.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 46-49"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethanol and lactate: Is there a direct association?","authors":"Megan Audette ,&nbsp;Damilola Idowu ,&nbsp;Amy Zosel ,&nbsp;Andrew Farkas ,&nbsp;Justin Corcoran","doi":"10.1016/j.ajem.2025.09.025","DOIUrl":"10.1016/j.ajem.2025.09.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Ethanol intoxication is frequently encountered in the Emergency Department (ED), often alongside comorbid conditions. Serum lactate, a clinical biomarker for illness severity, is hypothesized to elevate during acute ethanol intoxication due to altered redox states. Providers may defer lactate testing in intoxicated patients due to interpretation uncertainty, though this relationship remains unquantified.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of two cohorts of adult patients who had a serum ethanol measured during an ED encounter, one in a large academic health system from January 1, 2013 to January 30, 2023 and the other in the Veterans Health Administration (VHA) from 2010 to 2019. Patients with diagnoses or medications associated with lactic acidosis were excluded. A de-identified dataset including laboratory results, demographics, and vital signs were obtained. Descriptive statistics and regression analyses were performed.</div></div><div><h3>Results</h3><div>In the academic center cohort, regression analysis showed poor correlation between ethanol and lactate concentrations (<em>r</em>² = 0.00110). Subgroup analyses of ethanol concentrations &gt;80 mg/dL and &gt; 200 mg/dL also showed poor correlation (<em>r</em>² = 0.00570 and 0.00068 respectively).</div><div>In the VHA cohort, regression analysis similarly revealed no correlation (Pearson's correlation coefficient <em>r =</em> −0.00019 with <em>P</em> = 0.9899).</div></div><div><h3>Discussion</h3><div>This retrospective analysis found poor correlation between ethanol and lactate concentrations in both cohorts. Elevated lactate should not be attributed to ethanol alone. While effort was taken to exclude potential confounders, the causes of lactic acidosis are numerous, and confounders may remain. Prospective studies could better clarify any relationship between ethanol and lactate concentrations.</div></div><div><h3>Conclusion</h3><div>Ethanol intoxication does not justify deferring lactate testing when clinically indicated. Elevated lactate concentrations should prompt evaluation for alternative causes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 50-54"},"PeriodicalIF":2.2,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benzodiazepine-refractory status epilepticus: A narrative review","authors":"Jessica Pelletier ,&nbsp;Walter Merriman ,&nbsp;Alex Koyfman ,&nbsp;Brit Long","doi":"10.1016/j.ajem.2025.09.019","DOIUrl":"10.1016/j.ajem.2025.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Seizures are a common complaint in the emergency department, with status epilepticus (SE) associated with significant morbidity and mortality. While the typical first-line therapy for seizures includes benzodiazepines, patients with SE may be refractory to benzodiazepines. Seizures of longer duration are harder to break, and SE becomes a self-sustaining cycle; thus, benzodiazepine-refractory SE is a particularly challenging condition facing emergency clinicians.</div></div><div><h3>Objectives</h3><div>This narrative review provides a focused evaluation of SE refractory to first-line therapy, highlighting potential underlying causes and management strategies.</div></div><div><h3>Discussion</h3><div>SE may occur in 22 % of seizure cases presenting to the emergency department, and up to 40 % of these patients will have seizure activity refractory to benzodiazepine therapy. Prolonged seizure activity is associated with long-term neurologic consequences. Potential underlying causes of SE include endocrine, metabolic, infectious, neurologic, obstetric, toxicologic, and traumatic etiologies. Reversing these underlying causes can help terminate seizure activity. Benzodiazepines (lorazepam, diazepam, and midazolam) are considered first-line anti-seizure medications (ASMs) and must be administered in adequate doses to reach their maximum therapeutic potential. Patients who continue seizing should receive a second dose of benzodiazepines at the 5-min mark, combined with a second-line ASM, such as fosphenytoin (preferred over phenytoin), levetiracetam, or valproic acid. Patients who continue seizing are considered to have refractory SE and should receive third-line agents, such as ketamine, pentobarbital, propofol, or thiopental, as the clinician prepares for intubation. Continuous electroencephalography (EEG) should be considered when moving from second- to third-line ASMs or when intubation is necessary. Early aggressive therapy is key for terminating seizure activity.</div></div><div><h3>Conclusion</h3><div>Recognizing and treating SE early is critical for preserving neurologic function. Emergency clinicians must be prepared to reverse the underlying causes of SE and utilize second- and third-line ASMs to abort seizure activity when necessary.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 62-69"},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of rapid nucleic acid amplification tests and rapid antigen tests for influenza in the emergency department","authors":"Sukyo Lee,&nbsp;Jong-Hak Park,&nbsp;Hanjin Cho,&nbsp;Sungwoo Moon,&nbsp;Sejoong Ahn","doi":"10.1016/j.ajem.2025.09.022","DOIUrl":"10.1016/j.ajem.2025.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Influenza is a seasonal epidemic that poses significant health risks. Early antiviral treatment is recommended, making rapid and accurate diagnostic testing essential. Although rapid antigen tests (RATs) are widely used, they have limited sensitivity. In contrast, rapid nucleic acid amplification tests (NAATs) may offer improved diagnostic accuracy. This study compares the performance of a rapid NAAT and RAT for influenza in the emergency department.</div></div><div><h3>Methods</h3><div>This prospective comparative study evaluated the rapid NAAT (ID NOW Influenza A&amp;B, Abbott) and the RAT (BD Veritor System for Rapid Detection of Flu A + B, BD). Paired nasopharyngeal swabs were tested as point-of-care tests. Discordant results and agreement between the two tests were evaluated.</div></div><div><h3>Results</h3><div>A total of 453 patients were analyzed from December 2023 to February 2025. Mean age was 50.6 ± 20.6 years; 239 (52.8 %) were male. Influenza was detected in 166 (36.6 %) patients. Mean time from symptom onset to testing was 32.4 ± 62.1 h. Rapid NAAT-positive but RAT-negative cases were significantly more frequent (<em>P</em> &lt; 0.001), supporting the higher sensitivity of the rapid NAAT. Cohen's kappa coefficient between tests was 0.750 (95 % CI 0.685–0.815, <em>P</em> &lt; 0.001). This suggests systematic differences in sensitivity rather than random disagreement. Among patients tested within 48 h of symptom onset, discordance remained significant (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>In patients with suspected influenza in the emergency department, although rapid NAAT and RAT demonstrated good agreement, the cases that tested positive by the rapid NAAT but negative by the RAT were significantly more frequent. This suggests that rapid NAAT may be a more suitable diagnostic tool in the emergency department, as rapid NAAT can help avoid false negatives, enable timely antiviral treatment, and improve clinical decision-making within the critical treatment window.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 25-30"},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Electrocardiogram essentials: Bradycardia” Am J Emerg Med. 2025 Jul 13;97:58–64","authors":"Lloyd Tannenbaum MD ,&nbsp;Brit Long MD","doi":"10.1016/j.ajem.2025.09.005","DOIUrl":"10.1016/j.ajem.2025.09.005","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"97 ","pages":"Page 272"},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does obesity improve the prognosis of patients with community-acquired pneumonia? Insights from the MIMIC-IV database","authors":"Chuyu Zhong,&nbsp;Qingqiang Zeng,&nbsp;Jingtai Hu","doi":"10.1016/j.ajem.2025.09.020","DOIUrl":"10.1016/j.ajem.2025.09.020","url":null,"abstract":"<div><h3>Objective</h3><div>Positive associations between body mass index (BMI) and clinical outcomes have been found and are called “obesity paradox”. However, whether obesity has protective effects on critically ill patients with community-acquired pneumonia (CAP) remains unclear. Herein, this study aims to investigate the association of BMI with outcomes in critically ill patients with CAP.</div></div><div><h3>Methods</h3><div>This cohort study analyzed patients with CAP requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were categorized as underweight, normal weight, overweight and obese group. Study outcomes included 90-day mortality, sepsis development, acute kidney injury (AKI) occurrence, length of hospital stay (LOS), length of ICU stay and mechanical ventilation. Multivariate regression models and restricted cubic spline (RCS) regression were performed to analyze the impact of BMI on study outcomes adjusting for possible confounding variables.</div></div><div><h3>Results</h3><div>A total of 2874 eligible patients were enrolled in this study. The study population had a median age of 67.0 years with a male predominance (54.9 %). The underweight group had the highest mortality rate, while the obese group exhibited lowest rates. Obese was significantly associated with a longer length of ICU stay, duration of ventilation, and an increased risk of AKI. RCS analysis further confirmed a L-shaped relationship between BMI and 90-day mortality, with the lowest mortality risk observed at a BMI range of 33–35 kg/m². The incremental benefit of increasing BMI plateaued at 34 kg/m².</div></div><div><h3>Conclusions</h3><div>A relationship between obesity and mortality was identified in critically ill patients wi1th CAP. Notably, our study uniquely reveals that the relationship between BMI and 90-day mortality is non-linear, and there is no additional mortality-reducing benefit associated with increasing BMI levels among individuals with a BMI exceeding 34 kg/m².</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 55-61"},"PeriodicalIF":2.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective randomized trial of standard left anterolateral thoracotomy vs modified bilateral clamshell thoracotomy performed by emergency physicians in a live tissue penetrating cardiac injury model","authors":"Ryan Newberry DO, MPH ,&nbsp;Derek Brown MD, MPH ,&nbsp;Thomas A. Mitchell MD, MHA ,&nbsp;R. Madelaine Paredes PhD ,&nbsp;Vincent Nelson MD ,&nbsp;Renford Cindass Jr MD ,&nbsp;Dylan Rodriguez MSc ,&nbsp;Jae Hyek Choi PHD, DVSc ,&nbsp;Allyson Arana PhD ,&nbsp;Joseph K. Maddry MD","doi":"10.1016/j.ajem.2025.09.012","DOIUrl":"10.1016/j.ajem.2025.09.012","url":null,"abstract":"<div><h3>Objective</h3><div>Resuscitative thoracotomy (RT) is a critical, time-sensitive procedure that may be performed by emergency medicine (EM) physicians. The left anterolateral thoracotomy (LAT) is the technique traditionally used in the United States. However, its limited exposure may hinder effective intervention. The modified bilateral clamshell thoracotomy (MCT), developed by Barts Health NHS Trust clinicians at London's Air Ambulance (LAA), offers greater exposure and may be more suitable for EM physicians. This study aimed to determine the optimal RT technique for EM physicians while also assessing technical challenges, procedural concerns, and provider preferences.</div></div><div><h3>Methods</h3><div>EM staff and resident physicians from a level one trauma center participated after receiving standardized training on both MCT and LAT techniques. Participants were randomized to perform each technique on live tissue swine with a novel penetrating injury model. Success was defined as heart delivery from the pericardial sac, cardiac hemorrhage control, and full thoracic aorta occlusion. The primary outcome was time to successful RT completion. Secondary outcomes included procedural success rates, adequate exposure, hemorrhage control, cross-clamping success, iatrogenic injuries, and participant feedback.</div></div><div><h3>Results</h3><div>Ten EM physicians completed the study. There was not a significant difference in time to successful completion of the MCT and LAT techniques (585 s vs 664.9 s, hazard ratio 0.63, CI 95 % 0.27 to 1.49). Success rates were similar (80 % vs 70 %, difference − 10 %, 95 % CI -50.6 % to 30.6 %). Provider procedure preference favored the MCT over the LAT (100 % vs 0 %).</div></div><div><h3>Conclusion</h3><div>Though participants were more experienced with the LAT, the MCT performed as well and was universally preferred. The MCT may be the ideal technique for EM physicians confronting a penetrating thoracic injury with pulselessness or extremis in the absence of a surgical provider.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 70-75"},"PeriodicalIF":2.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anger at emergency department discharge increases chronic pain risk at four months","authors":"Florentine Tandzi Tonleu ,&nbsp;Claire Pilet ,&nbsp;Emmanuel Lagarde ,&nbsp;Cedric Gil-Jardine ,&nbsp;Michel Galinski ,&nbsp;Sylviane Lafont","doi":"10.1016/j.ajem.2025.09.017","DOIUrl":"10.1016/j.ajem.2025.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the impact of pain, stress, and negative emotions like anger, sadness, fear and regret in the persistence or development of chronic pain four months after admission to the emergency department (ED).</div></div><div><h3>Methods</h3><div>Data from 641 ED patients in the SOFTER IV clinical trial were analyzed. Pain, stress, and negative emotions were assessed at discharge, then dichotomized as non-severe or severe. Patients with chronic pain history were included in the analysis. Chronic pain at four months was evaluated using a binary yes/no question, and its predictors were identified using multivariable logistic regression with variable selection based on statistical significance.</div></div><div><h3>Results</h3><div>At four months post-ED admission, 35.1 % of patients reported chronic pain. As expected, a prior history of chronic pain was a strong predictor. Among patients with no history of chronic pain, those who reported severe anger at discharge were at nearly three times the risk of developing chronic pain (OR = 2.8, 95 % CI: 1.4–5.6). In addition, patients admitted for traumatic injuries and female patients also showed elevated risk, with odds ratios of 1.7 (95 % CI: 1.2–2.4) and 1.4 (95 % CI: 1.0–2.0), respectively.</div></div><div><h3>Conclusion</h3><div>Anger may affect the development or persistence of chronic pain after an emergency department admission.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 31-38"},"PeriodicalIF":2.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with immune-related adverse events in cancer patients treated with immunotherapy visiting the emergency department","authors":"Naomi Naud ,&nbsp;Sarah Addou ,&nbsp;Donia Bouzid ,&nbsp;Céleste Lebbé ,&nbsp;Gerard Zalcman ,&nbsp;Isabelle Madelaine ,&nbsp;Louise Nicolas ,&nbsp;Jean-Paul Fontaine ,&nbsp;Olivier Peyrony","doi":"10.1016/j.ajem.2025.09.010","DOIUrl":"10.1016/j.ajem.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to estimate the prevalence of immune-related adverse events (IRAEs) in patients treated with immune checkpoint inhibitors (ICI) who visited the emergency department (ED) and to identify patient characteristics associated with IRAEs.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients treated with ICI who visited the EDs of two University Hospitals between January 2017 and August 2024. The reason for emergency visit was attributed to IRAE if a diagnosis of IRAE was made during hospitalization or follow-up. Associations between explanatory variables (patient characteristics) and the outcome variable (presence of IRAE) were assessed using logistic regression and odds ratios (ORs) with 95 % confidence intervals [CI95 %].</div></div><div><h3>Results</h3><div>Among the 1330 patients who received ICI during the study period, 484 (36.4 %) visited the ED after treatment initiation, accounting for 898 visits. ED visits involved predominantly males (<em>n</em> = 573; 63.8 %), with median age of 64 years (IQR 54–73). The ED visits concerned most commonly patients with melanoma (<em>n</em> = 445, 49.6 %) and lung cancer (<em>n</em> = 409, 45.5 %). IRAE accounted for 135 (15 %) emergency visits. The most frequent IRAEs were digestive (31.5 %), endocrine (20.8 %), hepatic (13.7 %), neuromuscular (7.7 %), and pulmonary (6 %). Variables significantly associated with IRAE included male sex (OR: 1.67; 95 % CI: 1.07–2.60), diarrhea (OR: 3.96; 95 % CI: 2.42–6.49), and prior treatment with two (OR: 2.19; 95 % CI: 1.01–4.73) or three ICI drugs (OR: 3.59; 95 % CI: 1.46–8.82). Patients whose last ICI injection occurred more than six months before the emergency visit were less likely to experience IRAE (OR: 0.32; 95 % CI: 0.14–0.70).</div></div><div><h3>Conclusion</h3><div>This study reports that 36 % of patients with cancer treated with ICI visited the ED at some point after initiating treatment. These visits were related to IRAEs in 15 % of the cases. Diarrhea should prompt suspicion of IRAE (colitis), especially in patients who have received multiple ICI drugs within the last six months. Early recognition of IRAEs is important because early intervention may be associated with improved outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"99 ","pages":"Pages 17-24"},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varicella-zoster meningitis in immunocompetent adults: A case series and literature review.","authors":"Aliakbar Netterwala, Abdul Mannan Khan, B Seethalekshmi, Chinmay Nagesh, Parthasarathy Satishchandra","doi":"10.1016/j.ajem.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.ajem.2025.09.018","url":null,"abstract":"<p><strong>Background: </strong>Varicella-zoster virus (VZV) meningitis in immunocompetent adults is uncommon and can present atypically, sometimes mimicking raised intracranial pressure or occurring with minimal rash. We report a case series highlighting this spectrum and practical diagnostic points.</p><p><strong>Case presentations: </strong>Three immunocompetent adults (71-year-old man, 35-year-old woman, 52-year-old woman) presented primarily with headache and variable cutaneous findings: Case 1: Painful C5-C6 zoster followed by flaccid proximal right arm weakness; MRI brachial plexus showed inflammatory radiculoplexus involvement consistent with segmental zoster paresis. CSF demonstrated lymphocytic pleocytosis and was VZV PCR-positive. Case 2: Severe headache with papilledema mimicking idiopathic intracranial hypertension; CSF showed lymphocytic meningitis with positive VZV PCR. Case 3: Mild headache with a scant forehead lesion; CSF revealed lymphocytic pleocytosis and VZV PCR positivity. All patients received intravenous acyclovir with oral step-down where appropriate. No antiviral-related adverse effects were documented.</p><p><strong>Outcomes: </strong>Clinical recovery was favourable in all three cases; Case 1 showed proximal strength improvement on follow-up, and Cases 2 and 3 had resolution of symptoms by discharge. A brief literature review (1997-2023) underscores that VZV meningitis can occur in immunocompetent hosts and may present without a classic rash.</p><p><strong>Conclusions: </strong>VZV meningitis should be considered in the differential diagnosis of aseptic meningitis and raised intracranial pressure syndromes in immunocompetent adults. Early lumbar puncture with CSF PCR facilitates timely antiviral therapy and good outcomes.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}