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A 54-year-old woman presented with pruritic rash and hives of 3 days’ duration followed by shortness of breath for 1 day. SARS-CoV-2 PCR test for COVID-19 was positive. Cutaneous manifestations of COVID-19 include acral lesions, urticarial rash, erythematous maculopapular rash, vascular rashes and vesicular rash. The cutaneous manifestations are mostly described as self-limiting. Urticarial rashes are not reported as the initial presentation symptom of COVID-19 infection but mostly noted to occur at the same time or after the onset of non-cutaneous symptoms. Management of cutaneous manifestations of COVID-19 affecting quality of life has not been well studied. Antihistamine therapy is the primary recommended therapy. Role of antiviral therapy for severe cases of rash needs to be further assessed.

We report a case of pituitary tuberculosis which presented as a non-functioning pituitary macroadenoma, and subsequently developed multidrug-resistant tuberculous lymphadenopathy. Pituitary tuberculosis continues to be a rare presentation of tuberculosis, but incidence and prevalence are expected to grow with increasing numbers of multidrug-resistant tuberculosis. Isolated pituitary tuberculosis is rare. Tuberculosis should be considered in the differential diagnosis in evaluation of a sellar mass.

Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

Mesalamine, or 5-aminosalicylic acid, is a frequently used medication for the treatment of inflammatory bowel disease (IBD). We report the case of a 40-year-old woman recently diagnosed with IBD and started on mesalamine, who presented with new onset tender skin lesions 3 days following medication administration. One day following the onset of skin lesions, the patient developed acute chest pain, shortness of breath, ECG changes, troponemia, C-reactive protein elevation and pericardial enhancement on cardiac MRI consistent with myopericarditis. Subsequent skin biopsy confirmed the diagnosis of Sweet's syndrome. On cessation of the drug, both the skin lesions and the cardiac symptoms resolved in combination with anti-inflammatory therapy. While mesalamine has been previously associated with myocarditis and pericarditis, to our knowledge this is the first case of coexisting Sweet's syndrome with myopericarditis in the context of mesalamine therapy.

Thyroid ophthalmopathy is usually associated with Graves’ disease; however, in 6.2% of patients with thyroid eye disease it can be associated with hypothyroidism.1 A 54-year-old woman from Tamil Nadu presented to our outpatient department with sudden onset of binocular diplopia for the past 5 months. She subsequently noticed that her right eye became more prominent than her left eye. She had no other focal deficits or features of raised intracranial pressure. Along with these ocular symptoms, the patient had fatigue and increased drowsiness over the past 5 months and had gained around 3 kg of weight over the same duration. She however did not complain of constipation, voice changes, pedal swelling, cold intolerance or facial puffiness. She had no features suggestive of hyperthyroidism in the form of tremors, increased sweating, palpitations, hyperdefecation or restlessness. She had no history of hyperthyroidism. She had no history of receiving treatment for hypothyroidism or hyperthyroidism. There were no associated symptoms of neck swelling noticed by the patient; neither did she complain of any compressive symptoms. She also had no history to suggest associated autoimmune disorders. The patient was evaluated elsewhere initially for these …

Kallmann's syndrome is a rare form of idiopathic hypogonadotropic hypogonadism; impaired sense of smell and absent olfactory bulb are the hallmarks of this disease.1 ,2A 20-year-old man presented to us for evaluation of symptoms of a small-sized penis and testis, and poorly developed secondary sexual characteristics. His birth history revealed that he had been born with a cleft lip and cleft palate. The cleft lip was surgically corrected when he was 4 years of age. His …

We present a young patient with occasional chest pain and an incidentally found posterior mediastinal mass on radiology which was confirmed as mature teratoma on histopathology. The gross specimen received in the department of pathology was globular measuring 9.0×7.0×5.5 cm and varying in consistency from soft cystic to firm. Cut surface showed numerous hair entangled in pultaceous material. Representative sections were taken and stained with H&E stain. Histopathology revealed haphazardly distributed mature derivatives of all the three germ layers comprising of epidermis, pilo sebaceous units, nerve bundles (ectodermal), cartilage, bone, salivary gland clusters, blood vessels, muscle bundles, fibrous tissue infiltrated by foreign body giant cells, lymphoid follicles (mesodermal) and pseudostratified columnar epithelium (mesodermal), thus establishing the diagnosis of mature teratoma.