Herpes zoster infection also known as Shingles is caused by the reactivation of varicella zoster virus. Reactivations is most commonly triggered by increased age and immunosuppression. Association of Shingles with different vaccination is always a mystery. The mechanism is currently unknown about how the COVID-19 vaccination reactivates the virus. However, It is possible that the vaccine causes certain immunomodulation that allows varicella zoster virus to reactivate. We hereby report a rare case of Shingles appeared 5 days after COVID-19 vaccination. With the increase in COVID-19 vaccination all over the world, we believe that such cases should be reported for further studies.

Background: Rapid growing amyloid goiter (AG) is an extremely rare cause of thyroid gland hypertrophy associated with secondary forms of amyloidosis. Characterized by the presence of deposits extracellular amyloid protein in thyroid tissue in sufficient quantities to produce enlargement of the gland, it can be seen in chronic inflammatory disorders, with the common characteristic of amyloidotic renal failure.
Case presentation: We present a case of 24-year-old male in euthyroid with AG secondary to ankylosing spondylitis and chronic renal failure. Which showed a rapid enlargement of both thyroid lobes, eventually causing a loco-regional compression simulating a malignant process. Following total thyroidectomy. Diagnostic confirmation of amyloid goiter was established by microscopic examination.
Conclusion: In daily practice, practitioners should discuss differential diagnosis in patients with comorbidities suggestive of amyloidosis. The entity may be already suspected by radiology, but cytological and histological examination of amyloid deposits remain the keys attributes to establish the correct diagnosis.

Angiofibroma is a benign mesenchymal tumor. It’s clinical presentation is nonspecific and similar to other vulvar tumors. Angiofibroma has good prognosis,despite some risk of recurrence.We present a 44-year-old woman with a bulky left vulvar lesion.

Chilaiditi's sign describes the incidental radiographic finding of the bowel positioned between the right diaphragm and the liver. This is a rare condition typically mistaken for pneumoperitoneum, which may lead to unnecessary investigations or surgical procedures. CT scan can confirm the diagnosis.

Introduction Pleural effusions can be secondary to a myriad of conditions. Rarely can it be due to hypothyroidism as well. We present a case of massive pleural effusion resulting from hypothyroidism. Case A 75-year-old male with a history of liver cirrhosis, hypothyroidism and medication non-adherence was brought into the emergency department (ED) with shortness of breath and altered mental status. Physical exam and chest imaging was consistent with right sided pleural effusion. Effusion was exudative in nature. The hospitalization was complicated by multiple recurrences despite thoracentesis and pleurodesis. Labs revealed hypothyroidism and finally the patient was started on hormone replacement resulting in resolution of the effusion. Discussion Pleural effusion is a rare manifestation of hypothyroidism which is thought to be mediated by vascular endothelial factor. Both exudative and transudative patterns can be seen on pleural fluid analysis. Mainstay of treatment is hormonal replacement. Conclusion The clinicians need to be cognizant of the rare etiologies of pleural effusion. Due work-up should be done depending on patient presentation for a timely diagnosis and management.

Background: HELLP syndrome is a complication of the spectrum of hypertensive disorders of pregnancy [1]. It is an acronym which refers to the triad of Haemolysis, Elevated Liver enzymes and a Low Platelet count [1]. It may represent a complication or progression of severe preeclampsia; however, this relationship has been challenged by evidence that preceding hypertension or proteinuria is absent in about 15 to 20% of patients with HELLP syndrome [2].

Background: ¹⁸F-FDG PET is an emerging tool for atrial glucose metabolism evaluation in the field of atrial fibrillation (AF) and its usefulness in the assessment of left atrial structural remodeling during AF is unknown.
Case Summary:  patient with history of pulmonary sarcoidosis presented with symptomatic persistent AF. Cardiac sarcoidosis was suspected and  ¹⁸F-FDG PET was performed during AF. Images revealed an excellent suppression of ventricular physiologic myocardial 18F-FDG uptake.However, the wall of both the left and right atrium presented a diffuse and homogeneous ¹⁸F-FDG uptake. Pericarditis, myocarditis and cardiac sarcoidosis were excluded. After pulmonary veins isolation procedure, a follow-up ¹⁸F-FDG PET/CT was scheduled after 5 months of sinus rhythm (SR) with same preparation.  Images revealed a complete disappearance of ¹⁸F-FDG uptake in both atrial wall.
Discussion:  Glucose metabolism evaluated by ¹⁸F-FDG PET/CT is significantly increased in AF relative to SR. This suggests either higher overall myocardial metabolism and lower myocardial efficiency or metabolic shift to glucose as substrate in AF. This case report raises the question of the place of PET scanning as an interesting potential tool in the evaluation of the atrial remodeling process in AF patients.