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Background: Septo-optic dysplasia (SOD), a variable combination of abnormalities of cerebral midline structures, is a clinically heterogeneous syndrome. Psychiatric symptoms in SOD were implicated in one case due to abnormal regulation of neuroendocrine structures.Objective: Discussion of a case of SOD associated with psychosis and depression, exploring the role of anatomical and endocrine abnormalities in producing psychiatric symptoms.Methods: Literature was reviewed on the PubMed, Medline, and Web of Science. One case of SOD with psychosis was reported in 2008.Conclusions: Disruption of complex neural pathways, including the septum pellucidum and other limbic structures may have been involved in the psychiatric disturbances in this case. Further reporting of similar cases is needed for more understanding of these associations.

We read with great interest the recently published American College of Rheumatology (ACR) guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic (1). We greatly appreciate this effort by the ACR which will help rheumatologists optimize management of rheumatic illnesses during the coronavirus disease 2019 (COVID-19) pandemic. We would like to make an important addition to this "living document", and hope this to be addressed in future updates as more data becomes available.

Hydroxychloroquine, initially used as an antimalarial, is used as an immunomodulatory and anti-inflammatory agent for the management of autoimmune and rheumatic diseases such as systemic lupus erythematosus. Lately, there has been interest in its potential efficacy against severe acute respiratory syndrome coronavirus 2, with several speculated mechanisms. The purpose of this review is to elaborate on the mechanisms surrounding hydroxychloroquine. The review is an in-depth analysis of the antimalarial, immunomodulatory, and antiviral mechanisms of hydroxychloroquine, with detailed and novel pictorial explanations. The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for coronavirus disease 2019 (COVID-19). Finally, current literature associated with hydroxychloroquine and COVID-19 has been analyzed to interrelate the mechanisms, adverse effects, and use of hydroxychloroquine in the current pandemic. Currently, there is insufficient evidence about the efficacy and safety of hydroxychloroquine in COVID-19. KEY MESSAGES HCQ, initially an antimalarial agent, is used as an immunomodulatory agent for managing several autoimmune diseases, for which its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions. HCQ is generally well-tolerated although severe life-threatening adverse effects including cardiomyopathy and conduction defects have been reported. HCQ use in COVID-19 should be discouraged outside clinical trials under strict medical supervision.

The surgical resection timing of left atrial (LA) myxoma is still controversial in concern for the risk of further embolic phenomena if delayed surgery versus hemorrhagic transformation during early surgery. We describe a case of 60-year-old man without significant past medical history admitted with two-day of double vision and found to have LA myxoma. Multiple factors including clinical aspects and comorbidities should be evaluated to decide the favorable management.

Multiple evanescent white dot syndrome (MEWDS), an inflammatory retinal condition seen predominantly in young adult patients, is characterized by unilateral vision loss with variable scotomas. The etiology of MEWDS is currently elusive and the formal mechanism is unknown. However, it must be differentiated from other white dot syndromes (WDS). Fundus fluorescein angiography in MEWDS exhibits a “wreath-like” arrangement of hyperfluorescent lesions predominantly located in the outer retina. Herein we present a case of a 32-year-old Southeast Asian female who presented to the emergency department with peripheral blindness and central scotomas. The patient's daughter was diagnosed with hand-foot-and-mouth disease seven days earlier, which often presents as an extremely debilitating condition. Below, we elaborate on the etiology, pathogenesis, and diagnostic methods to elucidate the multifactorial causes of MEWDS and aid clinicians in diagnosis and treatment. Although associated with certain viral illnesses, to the best of our knowledge, there have been no reported cases of MEWDS in conjunction with hand-foot-and-mouth disease.

Transesophageal echocardiography (TEE) is a commonly utilized investigation in patients with atrial fibrillation to study the left atrial appendage (LAA) and exclude an appendage thrombus before proceeding with cardioversion. Although TEE is considered the procedure of choice for this purpose, it may sometimes offer a limited specificity due to common anatomical variations associated with either the LAA or the adjoining cardiac structures. We herewith present a patient with atrial fibrillation who underwent TEE and was found to have an echodensity in the vicinity of left atrial appendage that mimicked a thrombus. A careful further evaluation however confirmed that the echodensity actually was consistent with a dense epicardial fat pad. TEE imaging evaluation in different planes and angulations is thus paramount in establishing a correct diagnosis. Supplemental information from other imaging modalities such as cardiac computed tomography may sometimes offer an additional value, especially if the diagnosis remains unclear.

Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice. Although the precise mechanisms resulting in PDS are not well understood, this seems to be highly associated with patients who have some underlying ventricular dysfunction. Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.

Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of patients with type 1 diabetes. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function. The pathophysiology of CAN is complex, likely multifactorial, and not completely understood. Treatment is limited to symptomatic control of orthostatic hypotension, which is a late complication, and current strategies to reverse CAN are limited. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and complications of CAN as well as current treatment options.

A left ventricular (LV) apical thrombus is usually seen in patients with severe LV dysfunction from an anterior myocardial infarction (MI). A large LV thrombus, in the absence of wall motion abnormalities, should prompt further testing including cardiac MRI to diagnose other rare causes. A 76-year

Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. A 56-year-old woman with history of Hodgkin lymphoma came to an emergency with dyspnea for 2 weeks. Vitals showed blood pressure 90/60 mmHg