VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a rare genetic disorder originating from a somatic mutation in the hematopoietic stem cells. This syndrome was first described in 2020 and carries many clinical features that other conditions cannot explain. Widespread autoinflammation is the primary process the disease presents, with high morbidity and mortality in those who show signs of bone marrow failure. Treatment is complex, and response to current therapies is poor. Long-term prognosis carries a mortality of 50%. In addition, the advancement of new-generation messenger ribonucleic acid (mRNA) vaccines raises concerns about their safety in this population since it could trigger a vaccine-related autoimmune response. This case describes the hospital course of a male in his 50s exhibiting an unexplained cutaneous reaction to an mRNA COVID-19 vaccine. He was later diagnosed with VEXAS syndrome based on symptoms presentation and diagnostic workup.

The Allurion Elipse™ device is a swallowable balloon in the form of a capsule placed without endoscopy that serves the same purpose as an intragastric balloon (IGB) used for weight loss. We report a case of a 43-yearold female who presented with a complete gastric outlet obstruction confirmed by computed tomography (CT) scan. The patient initially failed conservative management; therefore, the IGB was later removed endoscopically. This is a rare complication and one of the first cases described in the literature; therefore, further studies are needed before its widescale implementation.

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which widespread activation of the immune system leads to a state of excessive inflammation causing tissue damage. While this condition is mainly established in the pediatric population; due to its rarity, physicians often do not suspect this condition in adults. However, while diagnostic criteria are based on protocols tailored for the pediatric society, recognizing this condition in a timely manner in adults is utterly important to prevent a dismal prognosis. In instances where a concomitant rheumatological disorder is present, the syndrome is referred to as macrophage activation syndrome (MAS). This report describes a case of an adult patient who presented with mucosal bleeding and abdominal pain who was later diagnosed with MAS.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that has been extensively described in its most common presentations. Its pathogenetic process is poorly understood, although it is theorized that endothelial damage and inflammation play a central role. Its prothrombotic nature affects multiple organs, including lungs, kidneys, and the central nervous system. Rarer are cutaneous presentations that can be triggered or displayed concomitantly with COVID-19. Purpura fulminans is a lifethreatening syndrome that results in skin thrombosis and hemorrhagic infarction. While its association is explicit in critically ill patients with sepsis, few or rare cases have been described to be linked with COVID-19. In this report, we present a case of a critically ill patient with COVID-19 who showed signs of purpura fulminans while in the intensive care unit.