With the second wave of COVID-19, there was a surge of cases of mucormycosis co-infection in our health center. We would like to present a case of a 53 years old man with COVID-19 positive status who later developed mucormycosis, with invasion of Maxillary sinus, jugular vein, digastric recess in MRI. He was managed with Amphotericin –B injection along with insulin therapy in sliding scale and Posaconazole thereafter for six months. Debridement of the lesion was done along with removal of inferior alveolar process of maxillary process and 3 molar teeth and a premolar tooth of upper left side.

Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.

Relapsing Polychondritis (RPC) is a rare systemic inflammatory disorder of unknown etiology and characterized by recurrent and progressive inflammation of the cartilaginous structures, particularly involving the auricles, nose and respiratory tract as well as extra-cartilaginous tissues, including eyes, heart, skin, central nervous and hematological systems. Its diagnosis can be difficult when the typical clinical features such as auricular chondritis are absent. Here, we report on a case of 43-year-old woman who presented with recurrent sore thorat, dysphagia, extertional dyspnea, cough and noisy breathing initially misdiagnosed as acute laryngitis who was eventually diagnosed as Relapsing polychondritis with tracheobronchial involvement. Chest computed tomography showed the diffuse involvement of tracheobronchial cartilage. Based on the, Damiani’s criteria, she was diagnosed as relapsing polychondritis even though there was no unique involvement of auricular cartilage, and high dose steroid and immunosuppressive therapy were then started. This case indicated that patients who have tracheobronchial cartilage involvement without definite auricular chondritis should be considered for relapsing polychondritis as a differential diagnosis. This case is reported to raise awareness of airway involvement in RPC and discuss its current management.

Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.

Sarcoidosis though a chronic multi-system granulomatous disease, predominantly involves respiratory system. Often asymptomatic, patients can present with lymphadenopathy, prolonged fever and shortness of breath. Acute respiratory distress syndrome (ARDS) is relatively uncommon presenting feature of the disease. Here we present a case of a 19 years old female presenting in acute respiratory distress syndrome, eventually being diagnosed as Sarcoidosis. Although different diagnostic criteria have been developed for early diagnosis of sarcoidosis, atypical presentations can always pose significant challenge and lag for the diagnosis.