Background: Hyponatremia (serum Na+ < 135 mmol/L) is the most common electrolyte abnormality detected in clinical practice and an important cause of mortality and morbidity in hospital settings. Hyponatremia in patients with pneumonia is usually mild but is associated with increased risk of intensive care unit (ICU) admission, prolonged hospital stays, and increased mortality rates. The purpose of this study is to understand the impact of varying degrees of hyponatremia and various other inflammatory markers on the severity and outcome of coronavirus disease-19 (COVID-19). Objective: The main objective of this study is to evaluate the prevalence of hyponatremia in COVID-19 patients and to assess the correlation between hyponatremia and severity and outcome of COVID-19. The other objective is to evaluate the correlation between various inflammatory markers and outcome (ICU vs non-ICU admission, discharged vs deceased) in patients with COVID-19 pneumonia. Methods: A total of 113 participants who have been diagnosed with COVID-19 infection by reverse transcriptase-polymerase chain reaction test were included in the study. Epidemiological, demographic, clinical, investigative work-up, and outcome data were extracted from electronic health records using a standard data collection form. Based on serum sodium levels, patients were divided into two groups: normonatremic (serum Na+ ≥ 135 mEq/L) and hyponatremic (serum Na+ < 135 mEq/L). Various clinical, laboratory, and outcome parameters were compared between the two groups. Results: Hyponatremia was present in 50 out of 113 (44%) patients in our study, and it was generally mild. There were more male patients in hyponatremia group ( P = .006), and hyponatremic patients were older than normonatremic patients ( P = .001). Forty (35%) of the 113 patients were transferred to the ICU, and 17 (15%) needed mechanical ventilation during their hospitalization. Interleukin-6 (IL-6) levels were higher in the hyponatremic group ( P = .022). Intensive care unit admissions and oxygen requirement were significantly higher in hyponatremic patients ( P = .001 and .016, respectively). Ferritin, lactate dehydrogenase (LDH), IL-6, total leucocyte count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were significantly elevated in those patients requiring ICU admission and those who died due to COVID-19. Conclusions: Our study revealed that demography, clinical features, radiographic findings, complications like renal insufficiency, and inflammatory markers like IL-6 play a considerable role in hyponatremic COVID-19 patients. Hyponatremia patients required significantly higher rates of ICU admissions and oxygen support. Our results suggest that monitoring inflammatory markers such as ESR, CRP, total white blood cell (WBC) count, ferritin, LDH, and IL-6 may serve as an early warning system for progression to severe COVID-19.

Coronavirus disease-19 caused by severe acute respiratory syndrome Corona virus-2 is characterised by wide heterogeneity in clinical presentation. The typical radiographic findings in COVID-19 include bilateral ground-glass opacities and/or consolidations predominantly affecting the lower lobes and posterior segments of lungs. Other rare abnormal radiographic findings include pneumothorax, pneumomediastinum and pneumopericardium. There has been an increased incidence of pneumomediastinum, a rare but potentially life-threatening complication during this pandemic. It may be spontaneous or secondary. Pneumomediastinum may be due to barotrauma, cytokine storm induced diffuse alveolar injury or direct viral infection of type I and type II pneumocytes. The presence of pneumomediastinum in COVID-19 patients may indicate extensive alveolar membrane destruction and those patients need close monitoring. There are no consensus guidelines in managing COVID-19 patients with pneumomediastinum. Higher mortality rates (70.58%) are reported in intubated COVID-19 patients with pneumomediastinum. The development of pneumomediastinum in COVID-19 should be considered as a poor prognostic factor.

Background Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterised by a range of neurological symptoms and signs, and distinctive neuroimaging findings reflecting vasogenic oedema. Posterior reversible encephalopathy syndrome has been described in association with many autoimmune diseases, but its association with mixed connective tissue disorder (MCTD) is very rare. After an extensive review of the literature, we found only three cases of posterior reversible encephalopathy syndrome in association with mixed connective tissue disorder. But unlike other cases, in our patient, PRES is the presenting manifestation of mixed connective tissue disorder which is first of its kind. Case presentation We present a 30-year-old female from Southern India who had initially reported with complaints of fever, multiple episodes of vomiting and cough with expectoration. She had accelerated hypertension and moderate thrombocytopenia. Two days later, she developed sudden onset of visual disturbances and had a drop in sensorium. Neuroimaging done was suggestive of atypical posterior reversible encephalopathy syndrome, and autoimmune workup was positive for mixed connective tissue disorder. With prompt blood pressure control and anti-seizure medications, she recovered completely. Conclusion Early diagnosis and prompt control of blood pressure, along with anti-seizure measures, play a crucial role in management. Awareness about this rare association is essential for early diagnosis and treatment, and therefore reducing the risk of permanent neurologic deficits. This case is being reported because of its rarity.

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Immunoglobulin G4 (IgG4)-related disease is a multi-organ, immune-mediated, fibro-inflammatory disorder characterized by tumefactive masses in the affected organs. Incidence and prevalence of IgG4-related disease (RD) are not clearly known and have slight male preponderance. It often involves multiple organs at the time of presentation or over the course of disease mimicking malignancy, Sjogren's syndrome, antineutrophil cytoplasmic antibodies associated vasculitis, infections. A thorough workup is needed to rule out these mimickers. A 33-year-old gentleman presented to us with history of progressive swelling in the right peri-orbital region for four years. On evaluation, abdominal imaging was notable for the sausage-shaped pancreas and hypoenchancing nodules in bilateral kidneys. Histological examination of right lacrimal gland revealed lymphoplasmacytic infiltrate and storiform fibrosis. Serum IgG4 levels were normal, and immunostaining was negative. A diagnosis of IgG4-RD was suggested because of multi-organ involvement, classical radiological and histopathological features. Awareness about IgG4-RD, an under-recognized entity is essential, as it is treatable, and early recognition may help in a favourable outcome. Appropriate use of clinicopathological, serological and imaging features in the right clinical context may help in accurate diagnosis. Elevated serum IgG4 levels and biopsy are not mandatory for the diagnosis.