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As the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues across the globe, more details about the disease manifestations and clinical course have been emerging. The main clinical presentation of the ongoing coronavirus disease-19 (COVID-19) pandemic is respiratory symptoms. Along with this, the involvement of the gastrointestinal system and associated symptoms have also been reported. Here we present a case of a 58-yearold patient who presented with acute abdominal pain and was diagnosed with acute pancreatitis. He did not have any respiratory symptoms, but had radiological evidence of lung involvement and was diagnosed to be positive for COVID-19.

Wunderlich syndrome is a rare clinical syndrome characterized by the sudden onset of spontaneous, nontraumatic hemorrhage into renal subcapsular and retroperitoneal region. We present the case of a 24-year-old hypertensive who presented with acute flank pain and was found to have perinephric hematoma. He was managed conservatively and the follow-up revealed complete resolution of the hematoma with no structural abnormality of kidney. His connective tissue disorder/vasculitis work up was also normal.

ObjectiveTo compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic.SettingA retrospective observational study was conducted comparing the demographic, clinical and laboratory characteristics of patients with COVID-19 infection admitted to a secondary care hospital, during the first and second waves of the pandemic.Participants1039 patients from the first wave and 991 from the second wave who had pneumonia on chest X-ray and had a confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab were included. Patients with a normal chest X-ray and those who had a negative PCR test despite a positive COVID-19 antigen test were excluded.OutcomeLength of stay, need for mechanical ventilation, final disposition and mortality were the key outcomes studiedResultsInfluenza like symptoms (18.5% in the first wave vs 36.1% in the second wave, p 0.001), cough (79.2% vs 87%, p<0.001) and dyspnoea (27.5% vs 38% p<0.001) were more common in the second wave. Second wave patients had significantly higher respiratory rate, lower peripheral oxygen saturation, needed more supplemental oxygen and had higher incidence of pulmonary embolism. More patients received hydroxychloroquine and antibiotics during the first wave and more received steroids, antivirals and interleukin-1 antagonist during the second wave. The second wave had a shorter length of stay (14.58±7.75 vs 12.61±6.16, p<0.001) and more patients were discharged home (22% vs 10%, p<0.001).ConclusionsPatients who presented during the second wave of COVID-19 pandemic appeared to be more ill clinically and based on their laboratory parameters. They required shorter hospitalisation and were more likely to be discharged home. This could represent greater expertise in handling such patients that was acquired during the first wave as well as use of more appropriate and combination therapies during the second wave.

Fever with a rash is a common case scenario that clinicians encounter in their practice. The ubiquity of the presentation is proportional to the magnitude of the physician's dilemma due to its numerous causes. The diagnosis varies from infectious diseases to non-infectious, life threatening diseases including the current COVID-19 pandemic. Here we present a case of a 31-year-old male, who presented to the Emergency Department with fever and rash and was initially diagnosed and managed as a case of COVID-19 which on further evaluation proved to be brucellosis. This is a case of brucellosis with cutaneous manifestations which had been masquerading as COVID-19.