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We describe a case of cutaneous mucormycosis in a middle-aged man with ethanol-related chronic liver disease. He presented with symptoms of fever, breathlessness for 10 days and altered mental status for 2 days. On admission, he was in septic shock and had acute respiratory distress syndrome (ARDS). He was noted to have ruptured blisters in his left axilla. Although he repeatedly had negative COVID-19 Reverse Transcription-PCR results, he had positive IgG antibodies for COVID-19. He was managed with broad-spectrum antibiotics, steroids, vasopressors and ventilation for ARDS. Over the course of his hospitalisation, the axillary lesion progressed to a necrotising ulcer with deep tissue invasion. Debridement and culture of the axillary ulcer revealed mucor species, and he was started on amphotericin and posaconazole for mucormycosis. Unfortunately, he continued to deteriorate despite aggressive management and died after a prolonged hospital stay of 40 days.

Gaucher disease is rare, inherited lysosomal storage disorder that leads to the excessive accumulation of certain lipids, especially within the bone marrow, liver, and spleen. We present a case of a 30-year-old man with Gaucher disease who underwent a splenectomy at the age of eight for severe cytopenia. His subsequent history was notable for recurrent avascular osteonecrosis and his liver disease progressed to portal hypertension, variceal bleeding, and refractory ascites. Upon evaluation of his candidacy for liver transplantation, he was sarcopenic, with tense, high serum-ascites albumin gradient (SAAG) ascites and florid venous collaterals on his anterior abdominal wall. His hepatic venous pressure gradient (HVPG) was 22 mmHg. He underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure, following which his HVPG was reduced to 2 mmHg and striking reversal of ascites as well as improvement of his nutritional state. TIPS was not complicated by hepatic encephalopathy. The successful outcome of TIPS in Gaucher disease with advanced hepatic disease underscores its utility as a bridge to liver transplantation with continuing enzyme replacement therapy.

We describe a case of a 69-year-old woman, a known case of compensated Hepatitis C cirrhosis, presenting with recurrent urinary tract infection (UTI) secondary to Salmonella Paratyphi B . She had recently tested positive for Salmonella Paratyphi bacteremia associated with UTI, managed with antibiotics. Two weeks later, she presented with fever and burning micturition with signs of abdominal distension and pedal edema suggestive of decompensation of cirrhosis. She had repeat positive urine cultures for Salmonella and was managed with broad-spectrum antibiotics, surgical stone removal, and supportive measures leading to resolution of symptoms and ascites. She was administered a prolonged antibiotic course on discharge for chronic shedding of Salmonella in the urine. UTIs are a common cause of decompensation in immunosuppressed states like liver cirrhosis, and rare infections like salmonella need to be identified and managed appropriately with sensitive antibiotics and the right duration of treatment.