Wellens syndrome

- a.k.a LAD coronary T wave syndrome
- criteria: characteristic T wave changes (deep inversion of T wave segment in precordial leads, generally leads V1 to V4) , history of anginal chest pain, normal or minimally elevated cardiac enzymes level, ECG without Q wave, without significant ST elevation, normal precordial R wave progression
- this syndrome represent preinfarction stage of coronary artery disease that often progress to devastating anterior wall infarction
- the characteristic pattern classically presents only during chest pain free period and is important to notice since it is a sign if LAD disease

Gestational pemphigoid

- a.k.a herpes gestationalis (not associated with herpes virus)
- thought to be caused by autoantibodies which cross react to the basement membrane
- rash can appear anytime after 12th week of pregnancy or just after delivery
- typically starts at the navel area and then spread over the entire body
- diagnosis confirmed by skin biopsy using direct immunofluorescence
- treatment: corticosteroid ointment or oral steroid

Ecthyma gangrenosum

- caused by Pseudomonas aeruginosa
- indurated plaque evolving into hemorrhagic bulla or pustule that sloughs, resulting in eschar formation; erythematous halo; most common in axillary, groin, perianal regions
- usually affects neutropenic patients

West Nile Virus infection

- transmitted by Culex mosquitoes
- associated with maculopapular rash, headache, ocular pain, sore throat, nausea, vomiting and arthralgia
- occasionally causes aseptic meningitis and severe encephalitis (incidence of neurological involvement ~ 1%)
- diagnosis is initially clinical and subsequent serological confirmation
- real time PCR of CSF may identify the viral RNA
- treatment is supportive
- interferon alpha has been the only treatment which may affect the outcome in West Nile encephalitis