Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a broad spectrum of manifestations. A variety of dermatological manifestations were described. We present a case of an immunocompetent middle-aged man who presented with novel coronavirus disease 2019 (COVID-19) and later developed herpes zoster (HZ). The case highlights the possibility of COVID-19-related HZ. The highest infection control measures must be abided when managing patients with cutaneous complaints until COVID-19 is ruled out.

Co-epidemics can create a burden on healthcare systems in the affected areas. The world, at present, is facing the pandemic of coronavirus disease. Nonetheless, many areas worldwide suffer from endemics that are not of less danger than the current pandemic. We presented a case of a patient diagnosed with dengue fever and was also found to have coronavirus through nasal swab, but immunoglobulin M and G were undetectable. Our case brings to notice the alarming probability of two co-epidemics happening simultaneously. However, through the presented case, our theory is that the dengue virus may cause a false-positive detection of severe acute respiratory syndrome coronavirus 2.

Patent foramen ovale (PFO) in patients with carcinoid heart disease (CHD) may result in hypoxia due to the presence of large right (R) to left (L) intracardiac shunts leading to hypoxia and worsening clinical condition. Percutaneous closure of the PFO can normalize oxygen saturation, relieve symptoms, and lessens left-sided heart valves involvement.We describe a case of a 70-year-old female patient with a history of small bowel neuroendocrine tumor on monthly octreotide infusion presented with worsening exertional dyspnea and hypoxia secondary to R to L intracardiac shunt through the PFO. The decision was made to close the PFO percutaneously with Amplatzer (Plymouth, MN: Abbott) PFO occluder device which resulted in immediate normalization of oxygen saturation and relief of her dyspnea.

Background: Hemoglobin Köln is the most widely diagnosed among unstable hemoglobin. Patients with hemoglobin Köln often have moderate hemolytic anemia, reticulocytosis, splenomegaly, and high levels of lactate dehydrogenase and bilirubin in the blood. Hemoglobin Köln happened as a result of the substitution of an amino acid methionine for the usual valine at position 98 of the beta chain. Up to the time, there were no previous reports in Arabian Peninsula, hence, the patient involved in this study is considered to be the first reported case. Case: A 13 years old Saudi male, product of consanguineous marriage, known to have chronic hemolytic anemia and jaundice since birth. Previously labeled as query Gilbert syndrome and treated with folic acid supplements by primary health care. However, due to the several emergency room admissions caused by severe left upper quadrant abdominal pain in association with dark urine, gallstones and hepatosplenomegaly, the patient was referred to pediatric hematology. Subsequent investigations identified that patient's vague and common complaints was a result of hemoglobin Köln disease. Those investigations showed mild macrocytic anemia, polychromasia, and bite cells in blood smear, while in hemoglobin electrophoresis, a small peak in zone (E) was observed. Hemoglobin Köln was confirmed by whole exome sequencing (WES) test that reported the presence of amino acid exchange (Val99Met). Recommendations: Careful examination is necessary for the differential diagnosis of hemoglobinopathy variations, which can be challenging especially in pediatric cases. Unstable hemoglobin should be investigated in cases mimicking a β-thalassemia trait, but associated with abnormally rapid hemolysis and reticulocytosis, or in cases that cannot be explained with common causes.