Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19.

COVID-19 caused by SARS-CoV-2 may present with a wide spectrum of symptoms ranging from mild upper respiratory tract infection like illness to severe pneumonia and death. Patients may have severe hypoxaemia without proportional features of respiratory distress, also known as 'silent' or 'apathetic' hypoxia. We present a case of a 56-year-old man with COVID-19 who presented to the fever clinic of our institution with fever and cough without any respiratory distress but low oxygen saturation. The patient deteriorated over the next 2 days but eventually recovered of his illness in due course of time. This case demonstrates 'silent hypoxia' as a possible presentation in COVID-19 and emphasises the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients.

Rowell's syndrome: a rare but distinct entity in rheumatology.

Rowell's syndrome is a rare disorder characterised by an association of lupus erythematosus with erythema multiforme (EM)-like skin lesions. EM as the initial clinical presentation of systemic lupus erythematosus is also atypical and even rarer. We report the case of an 18-year-old girl admitted to our hospital with fever and polyarthralgia along with multiple discrete ill-defined target lesions with crust formation over forehead, cheek, external ears, scalp, upper chest and back (predominantly over sun-exposed areas) with ulceration over hard palate. Investigations revealed pancytopaenia, a positive rheumatoid factor, positive antinuclear antibody with a speckled pattern, anti-Smith antibody and strongly positive anti-Ro. Patient was diagnosed with Rowell's syndrome as per clinical and laboratory features. Majority of skin lesions including oral ulcerations subsided gradually after treatment with steroids and hydroxychloroquine.

Two Uncommon Causes of Guillain-Barré Syndrome: Hepatitis E and Japanese Encephalitis.

We are presenting two cases of Guillain-Barré syndrome where it is preceded by hepatitis E virus (HEV) and Japanese encephalitis virus (JEV) infection, respectively. Our first case is a forty-three-year-old nondiabetic, nonhypertensive female who was initially diagnosed with acute HEV induced viral hepatitis and subsequently developed acute onset ascending quadriparesis with lower motor neuron type of bilateral facial nerve palsies and respiratory failure. Second patient was a 14-year-old young male who presented with meningoencephalitis with acute onset symmetric flaccid paraparesis. After thorough investigations it was revealed as a case of Japanese encephalitis. Our idea of reporting these two cases is to make ourselves aware about this potential complication of these two common infections.

Evaluation of respiratory manifestations in systemic lupus erythematosus with special reference to pulmonary interstitial involvement.

Different respiratory manifestations in systemic lupus erythematosus (SLE) are not uncommon. We lack sufficient Indian data in this regard. Forty diagnosed cases of SLE were evaluated, to find out the prevalence of respiratory manifestations in SLE, as also to correlate the findings as observed by different diagnostic methods. It was a single centre cross-sectional observational study conducted at rheumatology clinic, IPGME&R, Kolkata. Patients suffering from chronic airways obstruction, upper airway diseases, left ventricular failure and lung cancer were all excluded from the study. After clinical evaluation and routine testing of organ specific parameters, patients underwent spirometry and chest x-ray in all cases and pleural fluid study, pleural biopsy and high resolution CT scan of thorax selectively as required. Mean age at presentation was 26.8 years and female to male ratio was 39:1. Commonest respiratory symptom was dyspnoea and commonest respiratory manifestation was pleural effusion. Pleural effusion was bilateral in 80% of cases. Interstitial lung disease (ILD) was found in 10% of cases presented either subacutely or chronically. High resonance CT was found to be more sensitive to diagnose ILD, as in 50% of ILDs diagnosed by scan, chest x-rays were normal. Pleuropulmonary infections (7.5%) were next most common manifestation and tuberculosis was found to be the commonest cause. Lupus pneumonitis was found in one only (2.5%). Screening lung function test as done by spirometry, could pick up some abnormality in 50% cases and restrictive change was the major abnormality (47%). None showed evidence of bronchial hyper-responsiveness. No case was detected to have neuromuscular disease, acute respiratory distress syndrome or pulmonary thrombo-embolism. All the respiratory manifestations as noted appeared in variable period after the onset of SLE.