Sudden, involuntary spasm of the diaphragm associated with closure of the glottis will lead to a hiccup sound. Brief episodes of hiccups are often self-limiting and may be physiologically encountered in everyday life. However, prolonged attacks of hiccups are associated with significant morbidity. Herein, we present a rare and interesting case of coronavirus disease 2019 (COVID-19) induced persistent hiccups in a 61-yearold gentleman with no signs or symptoms of gastric pathology. As the patient required less oxygen supplementation, with inflammatory markers down-trending, his hiccups improved. The timeline of the symptom presentation and his response to treatment highly suggested that his hiccups were associated with COVID-19 infection. To the best of our knowledge, there are only two cases of persistent hiccups secondary to COVID-19 that have been reported thus far. Our case will add to the existing literature and highlight the potential association of COVID-19 with hiccups.

Since early 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of individuals and changed the face of medicine. As the fight against COVID continues, there is still unclear long term effects; although as time passes, more and more is being updated, in regards to the risks of exposure, length of recovery, outcomes of those infected, effectiveness of vaccines, and both expected and unique side effects of both the virus and vaccines, all in an array of individuals. This paper will review a unique topic of the SARS-CoV-2 virus and the abnormal immune response in a young patient. This case is unique due to the fact that there have been an abundance of side effects reported that are associated with the virus that affects every organ system, yet very few have affected the neurological and integumentary (skin) system. This case emphasizes the reactivation of a Herpes/Varicella-Zoster virus (VZV) in a young male shortly after he received the Pfizer-BioNTech COVID-19 vaccine. The other interesting aspect about this case is the patient’s immunocompromised state, as he was diagnosed with HIV several years before this viral reactivation occurred. The interesting aspect about this was trying to understand whether the VZV was truly reactivated because of an overly stressful immune reaction in response to the Pfizer-BioNTech COVID-19 vaccine or was it mainly due to the patient’s already weak immune system, or even a combination of both? The in-depth review will evaluate whether there should be more done in regards to bringing more awareness about potential side effects and preparing for a VZV reactivation and/or other dermatological complications after being vaccinated. This presentation could also simply be a very unique, isolated case, and that each individual should have no hesitations regarding the Pfizer-BioNTech COVID-19 vaccine.

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Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome that is often underdiagnosed. There are limited treatments and clinical outcomes documented in adults, more so in the immunocompromised population. Here, we described the clinical features, diagnosis, treatment, and clinical outcome of an HLH secondary to histoplasmosis in an AIDS patient.

Introduction:The risk of colonic perforation from a colonoscopy was found to be 0.03-0.8%. The risk of a fistula occurring after colonic anastomosis can be up to 10%. Currently, management has included fully covered self-expanding metal stents, endoscopic clipping with suturing, and endoscopic vacuum therapy. Case Description/Methods: We present a 61-year-old female patient, with a past medical history of hypertension, hyperlipidemia, gout, end-stage renal disease on peritoneal dialysis and awaiting kidney transplant who underwent a screening colonoscopy and had an iatrogenic perforation of the rectosigmoid area at 20cm from the anal verge from a presumed perforated diverticulum. Management consisted of an Exploratory Laparotomy with sigmoid colectomy and primary anastomosis. Four months later, the patient presented with passing stool through her vagina, consistent with a colo-vaginal fistula. She was admitted, and she underwent colonoscopy where an EGD scope was advanced about 12-15cm to the anastomosis site; however, it was difficult to identify the site of the fistula. A 50-50% mixture of cyanoacrylate and lipid oral solution were injected submucosally. Then, a 23mmx12cm fully covered esophageal stent was deployed with subsequent single stentfix OTSC clip from OVESCO was applied. Few days after the procedure, the patient was diagnosed with pneumoperitoneum without significant peritonitis, and this was managed conservatively. A month later, she underwent flexible sigmoidoscopy with removal of stentfix clip and the stent. There was a large ulceration from the stent dilation at the anastomosis site. Due to the size of the ulcer, no intervention was performed. Her pelvic pain resolved and she stopped passing stool through her vagina, but she continued to pass air through her vagina. Subsequent barium X-ray revealed a persistent colo-vaginal fistula, and flexible sigmoidoscopy was attempted 3 weeks later to help close the colo-vaginal fistula. The scope was advanced into the vagina and with the help of a catheter, a 021G guidewire was passed from the vagina through the fistula into colonic anastomosis. A Padlock clip was attached to the tip of the endoscope and inserted into the rectum. The fistula was centered with the help of the guidewire into the Padlock clip and the clip was released successfully. The guidewire was then pulled out from the vagina. Discussion: This case demonstrates a unique approach for patients with colo-vaginal fistulas for whom traditional techniques are unsuccessful.