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Abstract: Headaches are one of the most common medical complaints. The differentiation of benign primary headaches from the small number of patients with secondary headaches may be challenging, but failure to recognize a serious headache can be fatal. We report the case of a 49-year-old renal transplant patient, who was admitted to hospital because of intractable right-sided headaches. Cerebral imaging was unremarkable. Not until 2 days later did the patient develop a rash of grouped vesicles located in the right dermatome C3. Consecutively cerebrospinal fluid tested positive for Varizella zoster virus (VZV), indicating VZV meningitis. Therapy was started with intravenous acyclovir with rapid improvement. Here in we have described an atypical case of VZV reactivation in a renal transplant patient, who initially presented with headaches without any skin manifestation. Because of their compromised immune system, transplant patients have a high risk for visceral involvement of VZV infections, which are a life-threatening emergency. Therefore, vaccination of seronegative patients should be part of the pretransplant workup. Accurate and fast diagnosis of infection is essential to immediately start antiviral therapy. [Copyright &y& Elsevier]

Abstract: Background: Cutaneous vasculitis is a rare symptom after renal transplantation. With a broad spectrum of differential diagnosis, the new appearance of a skin rash in transplanted patients can be challenging. Case Report: We present the case of a 69-year-old man with palpable purpura, skin ulcerations, and diffuse arthralgias. He had a history of cadaveric renal transplantation owing to biopsy-proven isolated immunoglobulin (Ig)A nephropathy and never suffered from any skin manifestation before. Skin biopsy confirmed Henoch–Schoenlein purpura (HSP), which developed under maintenance immunsuppressive therapy with tacrolimus and mycophenolate mofetil. Renal biopsy showed recurrent IgA nephropathy with positive mesangial and capillary IgA staining. Discussion: This is the first case to describe a new manifestation of HSP following renal transplantation owing to isolated IgA nephropathy. Here, we summarize the differential diagnosis of cutaneous vasculitis following renal transplantation. Moreover we give a short review of the recurrence of IgA nephropathy and HSP after renal transplantation followed by possible strategies for prevention and therapy of recurrent disease. [Copyright &y& Elsevier]