Baffling Case of a Patient With History of Lupus in a COVID-19 Pandemic.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a myriad of clinical presentations and periodic flares. We present a case of a young lady with a history of SLE who presented with constitutional symptoms 1 week after starting Isoniazid and Rifampin for treatment of latent TB. Her presentation shared similarities with several diseases including TB lymphadenitis, SLE flare, Kikuchi-Fujimoto Disease (KFD) and hemophagocytic lymphohistiocytosis (HLH) posing a diagnostic dilemma. Additionally, she presented not long after the onset of the global COVID-19 pandemic, further expanding the differential diagnosis. She was ultimately diagnosed with a severe SLE flare caused by rifampin induced suppression of the CYP3A4 system, thereby reducing the therapeutic efficacy of steroids. This case highlights the deadly potential of drug-drug interactions, especially in patients with autoimmune conditions.

Atypical Pyoderma gangrenosum: a case of delayed recognition.

Pyoderma gangrenosum (PG) is an inflammatory skin condition that is often misdiagnosed as a necrotizing infection. This diagnosis must be considered in any patient with underlying systemic disease who presents with large ulcerating lesions that are unresponsive to antibiotics. Early diagnosis and a multidisciplinary approach to treatment are crucial to achieving improvement in quality of life and minimizing cosmetic morbidity. .

The many manifestations of a single disease: neuroborreliosis.

Lyme disease is a tick-borne illness that occurs in stages, multiple organs and tissue with highly variable clinical presentation. Most commonly, it presents with seventh cranial nerve palsy, often mimicking stroke and atypical rash (erythema migrans). Atypical presentations include abdominal pain, ileus/pseudo-obstruction and constipation thought to be due to autonomic dysfunction. Other less common presentations include Syndrome of Inappropriate Antidiuretic Hormones (SIADH). Lyme disease should be a differential when a patient presents from Lyme endemic areas with abdominal pain, constipation and SIADH in the setting of other causes of gastrointestinal and renal symptoms ruled out. Here we present a case of multisystem involvement in a single patient with Lyme Disease along with neuroborreliosis (neurological manifestation of Lyme disease).

Remdesivir in a pregnant patient with COVID-19 pneumonia.

Remdesivir is an antiviral drug currently being studied as a potential treatment of pneumonia caused by infection with SARS-CoV-2. The Adaptive Covid-19 Treatment Trial (ACTT-1) by NIH and the SIMPLE study by Gilead Sciences are two major trials that showed promising results of Remdesivir in the non-pregnant population. We are presenting the case of a pregnant patient who was diagnosed with COVID-19 pneumonia and successfully treated with Remdesivir.