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Severe acute respiratory distress coronavirus 2 (SARS-CoV-2) virus is responsible for the current pandemic - coronavirus disease 2019 (COVID-19) plaguing the world. It began spreading as early as January 2020 in the United States (US) and has recently become the leading cause of death amongst adults over 45 years of age. Much of its clinical presentation is already known, and there have been advances in its successful treatment with a food and drug administration (FDA) approved antiviral medication called remdesivir, and other proven investigational methods with clinical benefits including dexamethasone and COVID-19 antibody transfusion called convalescent plasma therapy. However, the recommendations for their use include COVID-19 confirmed patients requiring supplemental oxygen or other forms of respiratory support. In this case report, we describe in detail a unique case of severe COVID-19 infection that did not require any form of oxygen support but was treated successfully with antiviral medications and steroids. The purpose of this report is to highlight in detail an unusual COVID-19 presentation with rhabdomyolysis, myocarditis, and pancytopenia severe enough to require hospitalization and treatment with proven COVID-19 therapy to achieve clinical resolution.

Mesoamerican nephropathy (MeN), formerly called chronic kidney disease of unknown cause (CKDu), refers to chronic kidney disease (CKD) that presents in young and middle-aged Central Americans in the absence of any clear etiology. MeN is a relatively new diagnosis with rapidly rising prevalence in specific regions of El Salvador and Nicaragua, Guatemala, and Costa Rica. It is seldom associated with hyperuricemia. We present a case of a patient with gouty arthritis and hyperuricemia with associated CKD due to MeN. We also provide a review of literature of this disease.