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Chest pain is a common symptom culminating in hospital admissions and specialist referrals. Although cardiac work up is pursued in most of the cases, cardiac etiology is found to be the culprit in minority of the cases. Acute chest pain is a clinical syndrome that may be caused by almost any condition affecting the thorax, abdomen, or internal organs. On occasions this extensive and expensive diagnostic work up can be avoided with awareness of commoner and non-lethal reasons. We report a case of a woman with Bornholm disease secondary to Coxsackievirus B5 (CB5) infection and supplementary review of literature till date.

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Acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF) are increasingly identified as complications of coronavirus disease 2019 (COVID-19) infection, the latter being managed with tapering dose glucocorticoids. Studies have shown improved outcomes with steroid use in this subset of patients; however, the use of high doses of steroids predisposes these patients to develop various complications such as opportunistic infections. The incidence of pulmonary cryptococcosis (PC) in patients with post-COVID-19 PF is not known. Here, we discuss a middle-aged male, with no pulmonary comorbidities, who developed PC secondary to the immunocompromised state from high-dose steroid use for the management of post-COVID-19 PF.

COVID-19 infection has cardiovascular manifestations such as acute myocarditis, arrhythmia, ischemic cardiomyopathy, heart failure, pericardial effusion, cardiac tamponade, and thromboembolism. The COVID-19 mRNA vaccines BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and viral vector vaccine Ad26.COV2.S (Johnson & Johnson -Janssen) were initially approved for emergency authorized use by the US-FDA. Cases of myocarditis were reported primarily in adolescents and young adults after administration of COVID-19 mRNA vaccines, with the subsequent emergence of cases of myocarditis after administration of viral vector vaccine Ad26.COV2.S. A majority of these cases were observed after the second dose of the mRNA vaccine. This case report demonstrates the occurrence of symptomatic myocarditis in a patient during acute COVID-19 infection, followed by recurrence of symptoms after the first dose of mRNA COVID-19 vaccine and subsequent recurrence of cardiac MRI-proven myocarditis after the second dose of mRNA COVID-19 vaccine. This case stands out due to the occurrence of symptoms with COVID-19 infection and after vaccination, suggesting possible incomplete interval resolution of infection-related myocarditis.

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To the Editor We read with great pleasure the article titled 'Rectal Metastasis of Renal Cell Carcinoma'. We agree with the authors that metastasis of renal cell carcinoma to the large intestine is indeed rare (1). The authors have mentioned that delayed recurrence 21 years after surgery was the longest delay; however, there are reports describing recurrence occurring as late as 30 years after nephrectomy (2, 3).The American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) have specific guidelines for surveillance protocol for renal cell carcinoma following resection depending on the stage at the diagnosis (4, 5). It would enhance the reader's knowledge had there been mention of the patient's stage at the diagnosis, with appropriate recommendation on surveillance.

We report the case of a middle-aged male presenting with fatigue and abdominal pain. Prompt investigations demonstrated microangiopathic hemolytic anemia and thrombocytopenia on a peripheral blood smear. Thrombotic thrombocytopenic purpura was suspected based on the PLASMIC score. The patient significantly improved with therapeutic plasma exchange and prednisone within the next few days. The disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 levels reduction is a definitive hallmark leading to microvascular thrombosis. However, some medical centers in the United States do not promptly have quick allowance to the levels. Hence, the PLASMIC score becomes imminent in initiating immediate management and preventing life-threatening complications.