Case Report: COVID-19 Associated Renal Infarction and Ascending Aortic Thrombosis.

Following its discovery in Wuhan, China, in December 2019, COVID-19 has attained pandemic status in mere months. It is caused by SARS-CoV-2, an enveloped beta coronavirus. This infection causes a prothrombogenic state by interplay of inflammatory mediators, and endothelial, microvascular, and possible hepatic damage and tissue tropism of the virus. This leads to frequent pulmonary and cerebral thromboembolism as well as occasional involvement of other organs. We present a 71-year-old man who initially presented with 2 weeks of fever, cough, and shortness of breath and was diagnosed with COVID-19 pneumonia. He required readmission due to worsened hypoxia and was later found to have left renal artery thrombosis with left kidney infarction, associated with an ascending aortic thrombus. He was anticoagulated and recovered uneventfully. We suggest that physicians have a high degree of suspicion to diagnose and manage the novel manifestations of this disease.

Splenic Subcapsular Hematoma Complicating a Case of Pancreatitis.

Splenic subcapsular hematoma is a rare complication of pancreatitis. The splenic vessels and the pancreatic tail lie close together in the lienorenal ligament. The pathologies in the pancreatic tail may occasionally affect the spleen resulting in splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. A 40-year-old male with a history of alcohol abuse and alcohol-induced pancreatitis presented with severe epigastric abdominal pain and was diagnosed with pancreatitis. Later during hospitalization he became dyspneic and hemodynamically unstable, with acute anemia requiring blood transfusion. An abdominal CT with angiography (CTA) revealed a splenic subcapsular hematoma with active bleeding which was managed by urgent exploratory laparotomy and splenectomy. Due to its rarity, diagnosis of splenic hematoma in pancreatitis is challenging with rapid identification and intervention being key to management.

Spontaneous Rectus Sheath Abscess in an Intravenous Drug User.

Intravenous drug use has become a worldwide public health hazard and continues to affect all strata of our society. It has been associated with a multitude of severe infectious complications, such as hepatitis B, hepatitis C, human immunodeficiency virus, and endocarditis, though others such as skin and soft tissue infections are also extremely common. Rectus sheath abscess remains a rare medical condition. Here we report a 62-year-old man, who used heroin daily, presenting with an abdominal swelling with pain for two weeks. CT of the abdomen revealed a large left-sided rectus sheath abscess. Intravenous antibiotics were started and the abscess drained. The patient responded favorably to treatment. While managing complications of injection drug abuse, apart from the medical management, interventions to treat addiction assume prime importance. Rehabilitation, needle exchanges, and injection hygiene remain key to battling this malady.

Rhabdomyolysis in a Patient With Coronavirus Disease 2019.

Coronavirus disease 2019 has rapidly enveloped the world in a pandemic after emerging in Wuhan, China, in December 2019. We describe a 49-year-old man presenting with fever, cough, dyspnea, and myalgia diagnosed with coronavirus disease 2019 along with rhabdomyolysis and acute kidney injury. The creatine phosphokinase was elevated to 23,800 U/L before trending down to normal levels. Rapid identification and treatment with aggressive intravenous hydration and correction of electrolyte abnormalities remain key to successful management. In a pandemic, often atypical presentations of this new disease have to be considered as differentials for early diagnosis and treatment of life-threatening conditions.

An Uncommon Case of Partial Airway Obstruction due to Lingual Tonsillar Hypertrophy.

Obstruction of the airway is a medical emergency. If it is not treated immediately, rapid and potentially life-threatening hypoxia develops. A 70-year-old woman with a history of hypertension and palatine tonsillectomy presented to our tertiary care hospital with dysphagia, odynophagia, muffled voice, and neck swelling of a one-week duration. She also complained of associated shortness of breath that began two days prior to hospital admittance. Bedside laryngoscopy revealed an enlarged base of the tongue and laryngeal edema, resulting in partial airway obstruction. A CT scan of the soft tissue of the neck revealed that lingual tonsillar hypertrophy (LTH) was the cause of the partial airway obstruction. While being closely monitored, the patient was treated with intravenous corticosteroids and antibiotics. Serial laryngoscopies were performed to track the resolution of the airway obstruction. Her hospital course remained uneventful, and the patient was discharged after four days. Though rare, LTH has a strong propensity to cause airway compromise, and it must be treated at once.