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A 67-year-old white man presented, in 2010, with 6 weeks of double vision and left-sided periorbital pain with altered sensation. There was an incomplete third nerve palsy and altered sensation in the first and second trigeminal dermatomes. A malignant melanoma had been excised from his right forearm in 2003, with negative sentinel axial lymph node biopsy. In 2006, he had developed bilateral submandibular salivary gland enlargement, which histologically was chronic inflammatory sialadenitis.Plasma viscosity was persistently raised at 2.28 mPa/s (1.5-1.72) but serum C-reactive protein and serum ACE levels were normal. Chest x-ray showed left hilar prominence.Magnetic resonance scan of the brain showed extensive gadolinium-enhancing pachymeningeal thickening, including in the left Meckel's (trigeminal) cave ( figure 1A,B). Cerebrospinal fluid (CSF) was normal on two occasions, with negative cytology and absent oligoclonal bands.CT of the chest, abdomen and pelvis showed mediastinal and hilar lymphadenopathy. A soft tissue rim encased the distal aorta and the proximal common iliac arteries, suggesting either inflammatory tissue or retroperitoneal fibrosis. Positron-emission tomography with CT scan showed high uptake of radioactive 2-deoxy-2-[18F] fluoro-D-glucose in the hilar and right paratracheal lymph nodes Figure 1 T1-weighted gadolinium-enhanced axial magnetic resonance images of brain showing: (A) thickened meninges of the posterior fossa and left cavernous sinus; (B) marked meningeal thickening involving the falx and convexity meninges, without gyral or sulcal enhancement.

neutrophil to lymphocyte ratio, higher levels of ferritin, CRP and d-Dimer were found to be statistically significant factors in development of AKI. Mortality was found to be significantly higher in patients with AKI (12%) compared to patients without AKI (0.8%). Conclusions: AKI is common among patients hospitalised with COVID-19 and is associated with high mortality. Neutrophil to lymphocyte ratio, serum ferritin, CRP and d-Dimer are early markers to predict the development of AKI and assess the severity of infection, hence guide to better and appropriate measures in the treatment.

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