Complete persistent remission of rheumatoid arthritis after COVID-19 infection - A rare case and literature review.

A 55-year-old man was admitted to a hospital in Northeast India with fever, cough and breathlessness and was diagnosed with severe COVID-19 pneumonia. He was a known case of seropositive, erosive rheumatoid arthritis (RA) and was taking disease-modifying anti-rheumatic drugs (DMARDs). The patient was treated with remdesivir, heparin and a short course of corticosteroids for COVID-19 pneumonia. With the improvement of COVID-19 pneumonia, the patient also noticed a marked improvement in his joint symptoms despite not taking any DMARDs for RA. The temporal relationship between the time of disappearance of all signs and symptoms of RA within a few days after COVID-19 pneumonia and maintenance of RA remission for over one year of follow up to date suggests that COVID-19 likely caused the remission of RA. This case highlights the need for larger studies to understand the COVID-19 effects on RA remission and their potential link if any. However, the evidence of worse outcome with COVID-19 in immunosuppression which is common in RA cannot be overlooked.

Tracheal Diverticulum in SARS-CoV-2 Patients on Non-Invasive Ventilation A not so “Spontaneous” Cause of Pneumomediastinum? An imaging Pictorial Presentation of Two Cases with Review of Literature

Spontaneous pneumomediastinum is a rare but potentially life-threatening condition, the incidence of which has showed an increase in patients with SARS-CoV-2 pneumonia, especially when they are on positive pressure ventilation. None of the reported cases of covid related pneumomediastinum had an associated tracheal diverticulum. Also, to the best of our knowledge, tracheal diverticulum has not been reported in patients on NIV. We report 2 cases of COVID-19 pneumonia on NIV with pneumomediastinum, which also had associated tracheal diverticulum, one of which developed after NIV. Though the establishment of causality needs further research, early detection of a tracheal diverticulum, which might be a harbinger of pneumomediastinum, can be a timely alarm to prompt titration of the pressure settings and judicious use of NIV. The role of inverted grey scale CT images in mediastinal window is a simple, yet hardly utilised radiological tool to increase detection of ‘mediastinal air’, let it be free air or air within a diverticulum. Through this case report, we would like to highlight the role of conventional and inverted CT imaging of pneumomediastinum and tracheal diverticulum in general and in SARS-CoV-2 pneumonia in particular, and to call for more objective research to throw light on the plausible relationship between pneumomediastinum and tracheal diverticulum.