COVID-19: A Rare Cause of Hemolytic Uremic Syndrome.

Hemolytic uremic syndrome (HUS) is a multisystemic condition characterized by a triad of acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. HUS can be classified as atypical or typical, depending upon its association with the Shiga toxin-producing Escherichia coli (STEC). Approximately 90-95% of cases are classified as typical, while only 5-10% of cases are atypical. The pathogenesis of atypical HUS (aHUS) occurs when the complement cascade is activated and causes membrane attack complex (MAC) deposition in the renal tubular epithelium. Various infectious triggers have been associated with aHUS. A new and compelling correlation to this rare and potentially deadly diagnosis of aHUS is COVID-19 infection or vaccination. We present a case of COVID-19-induced exacerbation of a patient with a known history of aHUS. In addition, we performed a literature review of previously reported COVID-19-induced aHUS cases and identified the potential pathogenesis of the disease state.

Chronic Uncontrolled Hypothyroidism Associated With Dysphonia and Concurrent Pericardial Effusion.

Hypothyroidism is a commonly encountered pathology within internal medicine. It commonly presents with symptoms of fatigue, weight gain, constipation, and dry skin. Long-standing uncontrolled hypothyroidism can manifest with atypical symptoms of dysphonia and even pericardial effusion. This constellation of findings is not often encountered concurrently. While likely a consequence of uncontrolled hypothyroidism, it is prudent to ensure appropriate protection of the patient's airway and rule out other obstructive causes of dysphonia, such as malignancy. We present the case of a patient with uncontrolled hypothyroidism who presented with dysphonia. While treating hypothyroidism, the patient was found to have pericardial effusion. Other causes of obstruction such as vocal cord dysfunction and malignancy were ruled out via imaging studies and multidisciplinary discussion with other subspecialties.

A Case of Diastematomyelia Presenting With Minimal Neurologic Deficits in a Middle-Aged Patient.

Diastematomyelia is a rare congenital deformity of the spine in which the spinal cord is split into two hemicords along the sagittal plane. This condition belongs to the group of spinal dysraphisms, is more common in females, and is usually diagnosed prenatally or during childhood; rarely is it diagnosed in adults. We report a male patient in his 50s in which diastematomyelia of the thoracic spine was incidentally encountered after receiving a CT scan of the chest for shortness of breath. Although most patients with this condition are symptomatic, the patient did not display any significant acute neurological complaints at the time. The patient had a history of spina bifida and is paraplegic, both of which are commonly associated with diastematomyelia. The lack of progressive neurologic symptoms, diagnosis in the patient's adult life, and the presence of the anomaly solely in the thoracic spine make this a rare and unusual case. Early recognition and diagnosis of this condition, by prenatal ultrasound or MRI, can help to prevent further damage to the spinal cord and allow affected patients to seek treatment sooner, thus improving quality of life.