At the end of 2019, coronavirus disease 2019 (COVID-19) was first detected in Wuhan. In March 2020, COVID-19 became a global pandemic. Saudi Arabia registered the first case of COVID-19 on March 2, 2020. COVID-19 can affect any organ in the body. It affects the respiratory system predominantly. Reverse transcriptase-polymerase chain reaction (RT-PCR) is used to diagnose COVID-19, and the preferred swab is the nasopharyngeal swab. The shedding of the virus continues for about 20 days after the onset of the symptoms. There may be prolonged shedding in a few cases without any symptoms. Viral cultures are used for the confirmation of the shedding. Although the preferred mode of diagnosis is RT-PCR, enzyme-linked immunosorbent assay helps in the diagnosis of antibodies. Here, we report a rare case of prolonged viral shedding for more than 14 weeks. The patient had a prolonged COVID-19 infection, which caused immunosuppression, following which the patient presented with an infection.

VACTERL Association is complex, non-random sporadic association of various birth defects. It includes vertebral, anal anomalies, cardiovascular, tracheoesophageal, renal anomalies, radial anomalies and limb abnormalities.It is first described in 1970s. Full spectrum association is a very rare entity.VACTERL is considered to be present if any three of the above-mentioned abnormalities are present. Along with these features, patients might present with other external anomalies like lung lobation defects, external ear anomalies etc. However, the full spectrum of VACTERL association is very rare diagnosis mainly by clinical approach. Multidisciplinary approach and treatment of surgically correctable anomalies provide a better outcome for this association in new born period. Tracheoesophageal fistula is associated in more than 70 percent of the cases. Limb defects are also present in 70 percent of the cases. Anal atresia is present in 55 percent of the cases. VACTERL Shows phenotypic overlap with various conditions like Goldenhar syndrome, Fanconi anaemia, CHARGE syndrome etc. Here in we are reporting a case of VACTERL with presence of cardiovascular abnormality, Tracheoesophageal fistula and limb abnormalities.

The neonatal leukemoid reaction is an acute response of the body to stress. Any inflammatory processes in the newborn period may lead to an increase in the white blood cell (WBC) count. Hyperleukocytosis refers to an extremely elevated leukocyte count beyond 100,000/cubic millimeter (cumm). Here, we report a case of a leukemoid reaction in a newborn who presented with fever, swelling over the neck, and failure to thrive. Peripheral smear showed the presence of all precursors of white blood cells, but no blast cells were seen. Fine needle aspiration cytology (FNAC) did not show any abnormal cells or any evidence of leukemia. Hence, the diagnosis of a leukemoid reaction was made. Hyperleukocytosis presenting as palpable lymphadenopathy in a neonate is a rare finding that was seen in this case secondary to septicemia.

Holt Oram syndrome is a rare genetically inherited disorder characterized by various skeletal abnormalities of the upper limb with an underlying structural heart defect. Family history and conduction defects may or may not be there. The diagnosis is often clinical; if the criteria are not fulfilled, then genetic studies may be required. This syndrome can also occur with complex congenital heart defects, heart blocks, and arrhythmias. The correlation between the severity of cardiac and skeletal manifestations was not studied, and in severe conditions and acute presentation, the patient may have atrial, supraventricular, and ventricular fibrillation. The association of radius with hand deformity and the cardiac defect is well reported, but this disease's involvement of the humerus and Supraventricular tachycardia (SVT) is rare. Here, we are reporting a case of Holt Oram syndrome in a five-year male child with unusual skeletal hypoplastic humerus who presented with breathlessness, palpitations, and supraventricular tachycardia and suffered a total of three episodes which were managed with adenosine and cardioversion successfully. The involvement of the humerus, along with symmetrical bilateral radial defect with Atrial septal defect (ASD) and Supraventricular tachycardia (SVT), is a unique feature of Holt Oram syndrome seen in our case.