Systemic lupus erythematosus (SLE) is a chronic, multifaceted autoimmune inflammatory disease that can affect any part of the body. Peripheral gangrene is a rare manifestation of SLE. We describe a case of 26-year-old female who presented with complaints of bilateral lower limb rash, blackish discoloration of skin over right little finger and right third toe for past 2 months. On evaluation her anti RNP, anti SM and anti dsDNA antibodies were strongly positive. She was treated with IV unfractionated heparin, IV corticosteroids, IV antibiotics and other supportive measures.

Kounis syndrome is an acute coronary syndrome of varying degrees induced by allergic or anaphylactic reaction leading to coronary vasospasm or atheromatous plaque erosion or rupture or global myocardial hypoperfusion occurring as a result of systemic vasodilation and decreased venous return in context of anaphylaxis. We reported a case of 33-year-old female who presented to emergency department in an irritable state with complaints of nausea, vomiting, abdominal pain, breathlessness and generalized itching which developed secondary to administration of diclofenac injection by intra muscular (IM) route. On evaluation, echocardiography revealed global LV systolic dysfunction. The patient was successfully treated with continuous noradrenaline infusion, fluid resuscitation and other supportive measures with repeat echocardiography revealing normal LV systolic function.

Scrub typhus is a common re-emerging, acute febrile infectious disease, caused by orientia tsutsugamushi, transmitted by bite of chiggers of trombiculid mite. The clinical presentation of infection can vary from mild symptoms to severe multi organ failure, shock, encephalopathy, meningoencephalitis, DIC and various thromboembolic complications. We describe a rare hematological complication of deep vein thrombosis (DVT) caused by scrub typhus in a 61-year-old female. Vasculitis and perivasculitis with endothelial dysfunction could be considered as the main pathologic mechanism causing this complication.

Antiphospholipid syndrome (APS) is an autoantibody mediated acquired thrombophilia characterized by recurrent arterial or venous thrombosis and or pregnancy morbidity. We describe a case of 32-year-old female who had a medical history of APLA presented with complaints of abdominal pain for 20 days. On evaluation, CT abdomen contrast revealed celiac and splenic artery thrombosis. She was successfully treated with IV unfractionated heparin, warfarin and antiplatelets.