Post-COVID-19 Disease Associated with Mucormycosis and Guillain-Barré Syndrome: A Causal Association or Just a Coincidence?

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Originating from Wuhan, China, COVID-19 has rapidly spread worldwide. COVID-19 is primarily considered to be a respiratory illness, but with time there is enough evidence about the extrapulmonary manifestations of the disease. One of the neurological manifestations is Guillain-Barré syndrome (GBS). It may be associated with mucormycosis, with majority of cases occurring in India. Here, we report a case of a 40-year-old male patient, a known case of hypertension and diabetes mellitus who presented with the complaints of fever, cough and shortness of breath since May 10, 2021. He was found to be RT-PCR positive for COVID-19 on May 12, 2021. While recovering from COVID-19, on May 25, he was suspected to have rhino-orbital mucormycosis, which was confirmed on tissue specimen. While recovering from rhino-orbital mucormycosis, on July 26, the patient complained of weakness in bilateral lower limbs, followed by weakness in both upper limbs after 2 days. GBS was confirmed on nerve conduction study (NCS) and cerebrospinal fluid (CSF) examination. Patient was treated with intravenous immunoglobulin (IVIG), and while on treatment, the patient showed no significant improvement. Invasive ventilation was started in view of respiratory muscle involvement. The patient also developed autonomic dysfunction. He went into cardiac arrest and despite best efforts, couldn’t be revived. Currently, to the best of our knowledge, there is no data to tell that both mucormycosis and GBS can occur in association with COVID-19. This case aims to raise awareness among the healthcare providers for this type of association. COVID-19 may be a cause or it may just be a mere coincidence, needs further stud

Multi-organ Injuries Due to a Lightning Strike: A Rare Case

Injuries due to a lightning strike are uncommon presentations in the emergency department. Common injuries caused by lightning include burns, muscle pains, cardiac arrest, hearing loss, seizures, behavioral changes and ocular cataracts. We report a case of a 26-year-old primigravida with history of 3 months of amenorrhea who was struck by lightning as she was standing beside a tree. It left her unconscious, immediately after which she was taken to the emergency department of Maharana Bhupal Govt Hospital (MBGH Hospital), Udaipur, Rajasthan. Entry wound was from right ear and the exit wound was on abdomen. Examination confirmed linear first- and superficial second-degree burns. The electrocardiogram (ECG) showed deep and symmetrical T-wave inversion in precordial and lateral leads. There was an associated elevation of troponin T levels (peak: 432 ng/L), suggestive of myocarditis. On otoscopic examination, she was found to have rupture of tympanic membrane bilaterally. A transthoracic echocardiography revealed reduced ejection fraction of the left ventricle to 25% with global left ventricle hypokinesia, moderate mitral regurgitation and tricuspid regurgitation. This case aims to raise awareness among the healthcare providers regarding multiple organ involvement in lightning injury

Scrub Typhus with Multiple Cranial Nerve Palsy: A Rare Case Presentation

Scrub typhus, a rickettsial disease endemic in several parts of India, usually presents with acute symptoms. It is causedby small intracellular Gram-negative bacteria belonging to the Rickettsiaceae family. Optic neuritis and lateral rectus palsymay be associated with a range of autoimmune disorders, infectious diseases and raised intracranial tension. In this case,we report optic neuritis and lateral rectus palsy induced by Orientia tsutsugamushi. We report a case of a 23-year-old womanpresenting with complaints of high-grade fever, vomiting and generalized swelling since 5 days. During this febrile period,on 4/10/2021, she complained of difficulty in vision and double vision. She was found to be positive for scrub typhus on5/10/2021. Optic neuritis was diagnosed on the basis of ophthalmologic examination and magnetic resonance imaging (MRI)brain. Investigation was done to rule out autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial opticneuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. Fever, eschar,history of tick exposure and supportive diagnostic tests usually lead to the diagnosis. This case aims to raise awarenessamong the healthcare providers for this type of association. Scrub typhus should be included in the differential diagnosiswhen a patient presents with fever with or without eschar and isolated or multiple cranial nerve palsy

Multi-organ Injuries Due to a Lightning Strike: A Rare Case

Injuries due to a lightning strike are uncommon presentations in the emergency department. Common injuries caused bylightning include burns, muscle pains, cardiac arrest, hearing loss, seizures, behavioral changes and ocular cataracts. Wereport a case of a 26-year-old primigravida with history of 3 months of amenorrhea who was struck by lightning as shewas standing beside a tree. It left her unconscious, immediately after which she was taken to the emergency departmentof Maharana Bhupal Govt Hospital (MBGH Hospital), Udaipur, Rajasthan. Entry wound was from right ear and the exitwound was on abdomen. Examination confirmed linear first- and superficial second-degree burns. The electrocardiogram(ECG) showed deep and symmetrical T-wave inversion in precordial and lateral leads. There was an associated elevation oftroponin T levels (peak: 432 ng/L), suggestive of myocarditis. On otoscopic examination, she was found to have rupture oftympanic membrane bilaterally. A transthoracic echocardiography revealed reduced ejection fraction of the left ventricle to25% with global left ventricle hypokinesia, moderate mitral regurgitation and tricuspid regurgitation. This case aims to raiseawareness among the healthcare providers regarding multiple organ involvement in lightning injury