Several cases of Multisystem Inflammatory Syndrome in Adults (MIS-A) have been reported in adults since June 2020 after COVID-19 was first reported in December 2019. It was initially reported in children as MIS-C with Kawasaki-like disease, but a similar condition has been well recognized in adults. Although Mycoplasma co-infection has been reported with COVID-19, to our knowledge, concomitant Mycoplasma pneumoniae infection has not been reported together with MIS-A. We present a case of MIS-A with concomitant M. pneumoniae infection. It is unclear if concomitant Mycoplasma infection resulted in increased severity of the patient’s illness or if it resulted in inciting the immune response in our patient who had recently recovered from COVID-19 infection. This case highlights the need to diagnose a patient with a typical presentation of MIS-A and any concomitant infection or illnesses.

Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe2+) to ferric (Fe3+) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired; however, most cases are acquired and caused by exogenous substances such as medications, chemicals, and environmental substances. Phenazopyridine is an over-the-counter urinary analgesic medication commonly used for symptomatic relief of dysuria and has been reported to cause methemoglobinemia. However, only a handful of cases of phenazopyridine-induced methemoglobinemia have been reported. We present a case of an 89-year-old female who presented with severe hypoxia, shortness of breath, headache, nausea, and dizziness caused by phenazopyridine-induced methemoglobinemia. She was found to have a methemoglobin level of 21.5% and was treated with methylene blue, leading to a rapid improvement of her symptoms. She was taking one over-the-counter phenazopyridine 200 mg tablet three times daily for two weeks for her chronic dysuria. This case highlights the need to have a high index of suspicion of phenazopyridine-induced methemoglobinemia in a patient presenting with unexplained shortness of breath with a history of phenazopyridine use as it could lead to severe methemoglobinemia with hypoxia that could potentially be fatal if not promptly diagnosed.

Denosumab is a human monoclonal antibody used to prevent skeletal-related events in prostate cancer patients with bone metastasis. Hypocalcemia ranging from mild to severe requiring prolonged hospitalization have been reported with the use of denosumab in patients with known risk factors such as chronic kidney disease, vitamin D deficiency, low parathyroid hormone level, hypomagnesemia, extensive osteoblastic metastasis, prior use of bisphosphonates, and comorbidities impairing calcium absorption. We present a case of a metastatic prostate cancer patient with extensive osteoblastic metastasis who developed severe recurrent hypocalcemia after a single dose of denosumab requiring a total of 58 days of high dose intravenous and oral calcium supplementations with three inpatient hospital admissions. This case highlights the risk of severe hypocalcemia associated with denosumab use even after the disease control with oncologic therapy and in the absence of other predisposing risk factors. This case also emphasizes monitoring calcium levels closely in all patients treated with denosumab. In the event of severe hypocalcemia, prolonged hospitalization should be expected, and discharge planning should be done meticulously, which may help decrease the overall length of hospital stay, readmissions, and morbidity.

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Introduction: mRNA COVID-19 vaccines are very safe, but rare adverse events such as transverse myelitis have been reported after COVID-19 vaccination. Case Description: We report the case of 50-year-old man who presented with progressive lower extremity weakness, back pain and urinary retention after his second dose of the Pfizer COVID-19 vaccine. MRI of the spine revealed longitudinally extensive transverse myelitis (LETM). He recovered completely after treatment with intravenous methylprednisone and physical therapy.  Discussion: This case highlights the rare association between LETM and COVID-19 vaccines and encourages clinicians to maintain a high index of suspicion for prompt diagnosis and treatment.