Diffuse Rash Research Articles

FRI466 Toxic Retrosternal Goiter Following SARS-CoV-2 Vaccination

Abstract Disclosure: J. Schipper: None. Z. Abdul Sater: None. Since the outbreak of the SARS-CoV-2 pandemic, there have been reports of autoimmune thyroid diseases related to COVID inflection and SARS-CoV-2 vaccination. We report a case of SARS-CoV-2 mRNA vaccination (mCoVvax)-induced Graves with retrosternal extension. A 21-year-old Hispanic male with no previous history of thyroid illness presented with a 4-month history of tachycardia, tremors, agitation, unintentional weight loss, night sweats, low-grade fever, and orthopnea that developed 62 days after receiving the first dose of mCoVvax. His physical examination was significant for sinus tachycardia, hypertension, a resting tremor, brisk deep tendon reflexes, and diffuse nonpruritic maculopapular rash. His thyroid gland was diffusely enlarged with an unpalpable lower margin and positive Pemberton sign. TSH was undetectable with elevated Free T4 and Total T3 [11.0 (NL 0.8-1.8 ng/dL) and 800 (76-181 ng/dL), respectively]. Thyroid-stimulating immunoglobulin (TSI) was 337% (NL<140%), and thyroid peroxidase antibody was 653 IU/mL (NL < 9 IU/mL). Thyroid ultrasound showed a diffusely enlarged thyroid gland with diffusely increased thyroid uptake on technetium thyroid scan (95% and 85% uptake after 6 and 24 hrs, respectively), consistent with Graves’ disease. CT scan of the neck and chest confirmed retrosternal Goiter without tracheal deviation. He was treated with high-dose of Methimazole, Atenolol, and Prednisone. A literature search revealed five cases of Graves’ disease after mCOVvax, all of which did not have a retrosternal extension of the thyroid. Our case represents a rare complication of mCoVvax. Clinicians should consider retrosternal goiter in patients with thyrotoxicosis and orthopnea after mCoVvax exposure. Presentation: Friday, June 16, 2023

Concurrent Acute, Subacute, and Chronic Cutaneous Rashes in a Patient with Systemic Lupus Erythematosus

A 35-year-old woman with systemic lupus erythematosus presented with diffuse rashes. On exam, rashes of three different morphologies were seen throughout her body. A review of the cutaneous manifestations of lupus and the efficacy of belimumab for cutaneous lupus is provided.

OA14 The role of anifrolumab in treating life threatening systemic lupus erythematosus with severe mucocutaneous involvement

OA14 The role of anifrolumab in treating life threatening systemic lupus erythematosus with severe mucocutaneous involvement

A Case of Olanzapine-Induced Cutaneous Eruption.

BACKGROUND Different medication classes have been implicated in cutaneous eruptions that may lead to significant morbidity and mortality. In drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, the patient may initially present with a cutaneous eruption and hematologic abnormalities which can lead to acute visceral organ involvement if the offending drug is not discontinued. There is also a potential for long-term sequelae such as autoimmune disorders. CASE REPORT A 47-year-old woman with an unknown past medical history and no known drug allergies was admitted to the Behavioral Health Unit, where she was diagnosed with disorganized schizophrenia and started on olanzapine. On day 17 of admission, she developed a diffuse, macular, and erythematous rash on her abdomen, which spread to involve over 50% of her total body surface area. Occipital and posterior auricular lymphadenopathy was present. The patient was treated with prednisone and diphenhydramine. Olanzapine was subsequently discontinued and the patient's rash cleared up. CONCLUSIONS This case report highlights the challenges in diagnosing DRESS syndrome and the potential for antipsychotics to cause DRESS syndrome. DRESS syndrome is a clinical diagnosis augmented by laboratory tests with a wide range of patient presentations. Although there are probability criteria to assist with diagnosis, not all patients will fall exactly into these criteria, which can lead to missed diagnoses and poor patient outcomes. A challenge with DRESS syndrome diagnosis is the latency period between drug initiation and cutaneous eruption. Thus, in differential diagnoses for skin eruptions, temporal associations (minutes, days, weeks) with medications are crucial.

A de novo heterozygous variant in ACOX1 gene cause Mitchell syndrome: the first case in China and literature review

BackgroundMitchell syndrome (MITCH) is a rare autosomal dominant hereditary disorder, characterized by episodic demyelination, sensorimotor polyneuropathy and hearing loss. MITCH is caused by heterozygous mutation in the ACOX1 gene, which encodes straight-chain acyl-CoA oxidase, on chromosome 17q25.1. Only 5 unrelated patients have been reported so far, and no reports from China. Here, we describe the first MITCH case in a Chinese individual.Case presentationA 7-year-old girl initially presented with diffuse desquamatory rash at age 3. Her clinical symptoms in order of presentation were diffuse desquamatory rash, gait instability, ptosis with photophobia, hearing loss, abdominal pain, diarrhea, nausea, and dysuria. Genetic analysis demonstrated that the patient carried a heterozygous variant c.710A>G(p.Asp237Ser) in the ACOX1 gene, which can cause MITCH symptoms. This is the first MITCH case with gastrointestinal and urinary tract symptoms. After administrating N acetylcysteine amide (NACA), some symptoms were relieved and the patient’s condition improved.ConclusionThis is the first MITCH case in the Chinese population, and we expanded the genotype spectrum of it. The p.Asp237Ser may be a mutational hotspot in ACOX1 regardless of race. In terms of diagnosis, patients with recurrent rash, gait instability, and hearing loss with some autonomic symptoms should raise the suspicion of MITCH and proper and prompt treatment should be given.

#6605 A CASE REPORT OF MEMBRANOUS NEPHROPATHY SECONDARY TO SYPHILIS: A STEROID-RESPONSIVE DISEASE?

Abstract Background and Aims Membranous Nephropathy (MN) is among the most common forms of nephrotic syndrome in the adults. MN in adults is most often primary (75-80%) and caused by circulating autoantibodies against podocyte antigens being PLA2R the most important target. In the remaining 20-25% of cases, the MN lesion is associated with various disorders, including infections, autoimmune diseases, thyroiditis, malignancies, and the use of certain drugs. Syphilis is a chronic bacterial infection caused by Treponema Pallidum that can present in the primary, secondary or tertiary forms. Kidneys can be involved during either the secondary or the tertiary phase and the most frequent clinical presentation is nephrotic syndrome underlying membranous nephropathy. Here, we present the case of a 47-year-old man who developed rapidly progressive acute kidney injury, nephrotic syndrome and a blotchy diffuse macular rash secondary to Treponema Pallidum infection. Method Data review and collection of clinical records, kidney biopsy evaluation, treatment and outcomes description. Results A 47-year-old man presented to our hospital complaining about asthenia and dizziness. He reported recent use of both antinflammatory drugs and antibiotics to treat an anal fissure. His past medical history was notable for previous drug abuse and alcohol consumption. Physical examination highlighted peripheral edema and a diffuse macular rash. Serum analysis showed serum creatinine of 2.06 mg/dL, urea 84 mg/dL, haemoglobin 13.8 g/dL, albumin 4 g/dL and protein/creatinine ratio of 17741 mg/g; urinary dipstick was positive for haemoglobinuria and proteinuria. Urine collection revealed 22 g proteins/24h. Kidney ultrasound showed normal kidneys with a preserved cortico-medullary differentiation and thickness. In the next days kidney function worsened (serum creatinine 3 mg/dL and urea 100 mg/dL) and daily proteinuria reached a peak of 35 g/24h. A complete panel of antibodies was searched. IgG4 against PLA2R were negative. ANA, ENA and ANCA were absent, C3 and C4 were in the normal range. Serologic testing for HBV, HCV and HIV were negative. Empiric steroid therapy with prednisone 1 mg/kg/day was started obtaining a rapid improvement in terms of proteinuria and kidney function (Fig. 1), the cutaneous rash fainted. Kidney biopsy was performed and demonstrated a membranous nephropathy. Serologic testing for syphilis revealed positive TPHA (titer, 1:2560; normal value, <1:80) and a positive Venereal Disease Research Laboratory test (VDRL) (titer, 1:32; normal value, <1:2). The presentation suggested the diagnosis of anti-PLA2R negative membranous nephropathy secondary to systemic syphilis. Because of the serious clinical manifestation and the unknown duration of the infection we decided to treat the patient with Benzathine penicillin G 2.4 million units administered as three doses at one week intervals (Schön & Bertsch, 2016). Oral steroid was maintained at a dose of 1mg/kg/body weight and descalation started after 30 days. The proteinuria also improved with a reduction in the 24-hour collection from 30 g to 200 mg and serum creatinine went back to normal. Clinical course according to treatment phases are summarized in Fig. 1. Conclusion As far as we know, this is the first case of PLA2R negative membranous nephropathy secondary to syphilis. Although, antibiotic therapy is pivotal in syphilis treatment, our patient showed a fast improvement of kidney function, proteinuria and fainting of the cutaneous erythema after steroid therapy and before starting antibiotic therapy. This suggested the possible role of steroids in treatment of secondary T. Pallidum infection complicated by anti-PLA2R negative membranous nephropathy. Further researches are needed to better define the possible role of steroids in the context of an infective but immune-complex mediated nephropathy.

Antibiotic-induced DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) in an infant with Down syndrome

IntroductionDrug Rash with Eosinophilia and Systemic Symptoms syndrome (DRESS) is a rare but serious drug reaction. This syndrome is associated with an immune reaction triggered by the use of certain medications. Rare cases of DRESS have been reported in early infancy or in infants with chromosomal disorders, making their prognosis unknown. ObservationA 20-month-old infant with trisomy 21 was hospitalized for a febrile (39°C) rash with systemic symptoms. He had been hospitalized twenty days earlier for pneumonia, which was treated with antibiotics (cefotaxime and vancomycin). Physical examination revealed facial edema, a diffuse maculopapular rash involving the entire body and face and cervical lymphadenopathy. Laboratory tests showed leukocytosis with eosinophilia and liver damage (liver transaminases were 20 times the normal level). The diagnosis of DRESS syndrome due to antibiotics was made based on a RegiSCAR score of 7. The infant was treated with IV corticosteroids at a dose of 1mg/kg/day, along with a 2g/kg infusion of gammaglobulin. Clinical and laboratory improvement was observed with disappearance of skin lesions and normalization of laboratory values. DiscussionThe diagnosis of DRESS syndrome due to antibiotics was made based on a RegiSCAR score of 7. This class of drugs is the leading cause of DRESS syndrome described in children. The evolution of our infant patient with Down syndrome and DRESS syndrome was favorable.

Acute diffuse rash on trunk

Acute diffuse rash on trunk

Treatment of Omenn syndrome using multiple immunosuppressive strategies: a case series

Introduction: Omenn syndrome represents a therapeutic challenge as a state of florid immune dysregulation born out of autoreactive oligoclonal T cells due to hypomorphic variants in genes associated with severe combined immunodeficiency (SCID).Aims: To describe the therapeutic strategies used in the care of three patients with Omenn syndrome from 2013 to 2022. All had negative maternal engraftment studies and received immunosuppression to control autoreactive T cells. All patients ultimately received myeloablative conditioning with anti-thymocyte globulin (ATG), busulfan, and fludarabine for transplant. All patients are currently alive and well.Case 1: 2-month-old female with adenosine deaminase (ADA)-deficient SCID on pegylated ADA replacement developed respiratory distress, rash, and diarrhea in the setting of rising CD3+/CD4+/CD45RO+ cell count. Treated with high-dose systemic steroids. Due to continued CD3+ increase, systemic tacrolimus was added. She clinically improved and underwent matched unrelated donor cord blood transplant at 5 months of age.Case 2: A male with RAG1-SCID developed generalized erythroderma and rapidly rising CD3+/CD4+/CD45RO+ cell and absolute eosinophil counts soon after birth. Systemic steroids were given with clinical improvement. With taper of steroid, ATG 1 mg/kg was given. Initially, the absolute lymphocyte count (ALC) improved; however, within 5 days, his rash worsened and ALC rose. This necessitated re-initiation of high-dose steroids and addition of tacrolimus until matched related donor bone marrow transplant (MRD BMT) at 2 months old.Case 3: 9-day-old male with RAG1-SCID developed diffuse maculopapular rash, lymphadenopathy, and elevated memory T cells and eosinophils. Initiated high-dose systemic steroids and cyclosporine A (CSA) with quick clinical improvement. CSA discontinued due to toxicity and rising ALC and eosinophils. Given ATG 3 mg/kg/dose for 4 doses over 2 weeks with pattern of quick drop then rapid rise in ALC. Treated with steroids and tacrolimus until MRD BMT at 2 months old. ConclusionsWe describe consistent disease control with immunosuppression by systemic steroids and tacrolimus prior to transplant and suggest ATG as a potential adjunctive consideration in poorly-controlled disease. A growing body of knowledge and experience in optimal Omenn syndrome treatment strategies is imperative to improving outcomes.

Localized Petechiae in the Anterior Chest Wall in a Patient with Thrombocytopenia

Thrombocytopenia is a very common hematological disorder that can be seen in many diseases such as splenomegaly diseases, infectious diseases, microangiopathic hemolytic anemias (TTP, HUS) that may occur due to drugs and malignant diseases infiltrating the bone marrow. Thrombocytopenia causes bleeding diathesis and causes petechial and purpuric rashes on the skin and mucous membranes. The petechial eruptions seen in thrombocytopenia are generally widespread throughout the body and are not limited to a single area. In this case report, we wanted to present a 78-year-old patient with thrombocytopenia, who had a diffuse and intense petechial rash on the anterior chest wall secondary to thrombocytopenia but did not have petechiae in other parts of the body.

Gemcitabine-associated DRESS syndrome: A case report.

Gemcitabine is a well-tolerated pyrimidine antimetabolite chemotherapeutic that is increasingly utilized to treat non-small cell lung carcinoma, breast, pancreatic, and urogenital cancers. Myelosuppression is a common side effect and skin rashes can be observed. We discuss a case of the exceedingly rare DRESS syndrome, which appeared following Gemcitabine treatment. A 60-year-old patient with pancreatic cancer and liver metastases received therapy with Gemcitabine as a single agent. Fever, itching, and redness started to be reported on the third day of receiving Gemcitabine treatment. The patient's diffuse maculopapular rash steadily got worse, leading to hospitalization. In the patient's physical examination, a high fever, hepatomegaly, and a diffuse macular papular rash were detected, an increase in eosinophils in the complete blood count and peripheral blood. A skin biopsy was performed. It was determined that the patient had Gemcitabine-associated DRESS syndrome. Antihistamines and local steroids were administered. On the fifth day following treatment, skin lesions and eosinophilia decreased. The most common cause of DRESS syndrome, a disorder marked by extensive skin eruption, fever, eosinophilia, and systemic symptoms, is medication use. Infections including HHV-6, EBV, and CMV can occasionally be the reason. Gemcitabine is one of the medications that is frequently used in cancer, and a case was provided because the literature review did not mention Gemcitabine-related DRESS syndrome.

An unusual clue in the diagnosis of primary Sjogren’s syndrome

Sjogren’s syndrome (SSj) is a chronic autoimmune disease mainly targeting the exocrine glands, but sometimes associating extra-glandular manifestations. Xerosis, purpura, Raynaud’s phenomenon, cutaneous vasculitis, annular erythema are the main forms of skin involvement. A 26-year-old female patient was admitted for diffuse erythematous rash and angioedema, xerophthalmia and symmetrical arthralgia of hand joints. Anti-nuclear antibodies, anti-SSA and anti-Ro52 antibodies were identified, Schirmer’s test was positive, thus the diagnoses of primary SSj and associated urticarial vasculitis were established. Treatment with oral methylprednisolone, azathioprine and hydroxychloroquine was initiated, with favorable response over the next week. Patients with primary SSj that develop cutaneous vasculitis, lymphadenopathies or lymphopenia may be at risk for additional extra-glandular manifestations, including non-Hodgkin lymphoma.

Oral ivermectin treatment for an infant with crusted scabies.

A fully vaccinated 4-month-old girl with normal development was referred to our dermatology clinic for an intensely itchy, diffuse papular rash that had been present for 3 months. Her family physician had initially diagnosed eczema and treated with betamethasone valearate 0.05% ointment, but later

Monkeypox in children and elderly: correspondence.

Monkeypox in children and elderly: correspondence.

Multisystem inflammatory syndrome in children associated with Bacille Calmette-Guérin scar: a case presentation

BackgroundDuring Coronavirus disease of 2019 (COVID-19) pandemic, the WHO reported a noticeable increase in Kawasaki disease prevalence in countries where Kawasaki disease is rare. This newly seen disease, unlike typical Kawasaki disease, tends to appear at a later age, has prominent gastrointestinal findings, higher rates of myocarditis and coronary artery involvement and a greater need for admission to the intensive care unit (ICU). Induration of the Bacillus Calmette-Guerin (BCG) scar is a rare finding seen in multisystem inflammatory syndrome (MIS-C). This is the second reported case of erythema and induration of the BCG scar in a 1-year-old boy with MIS-C.Case presentationThe Arabic boy presented with high resistant fever, nausea/vomiting, diarrhea, erythematous lips, and conjunctivitis. He later developed induration of his BCG scar, diffuse rash and desquamation on fingers and toes. He had a history of COVID-19 exposure as his IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive. Based on his clinical findings and repeated lab results, he was diagnosed with MIS-C with Kawasaki features and treated with intravenous immune globulin (IVIG) followed by methylprenisolone and aspirin.ConclusionsReaction at the BCG inoculation site is not a diagnostic criteria for Kawasaki, but it is seen clinically in 30-50% of the patients. We report the case of a 1-year-old boy diagnosed with MIS-C presenting with erythema and induration of BCG scar. Further studies are needed to explore this clinical presentation, especially in the countries that have BCG vaccination programs, and to determine the mechanisms of MIS-C.

Vaccine Induced Herpes Zoster in An Immunocompetent Child After 3 months of 1st Dose of Vaccination

Varicella zoster virus (VZV) is an enveloped double stranded linear virus, which belongs to the herpesvirus’s family. It can cause two clinically different forms of diseases, primary infection known as chicken pox and latent infection know as herpes zoster (Shingles). Primary infection presents with diffuse vesicular rash accompanied by fever, malaise, and pharyngitis. However, latent infection results from reactivation of dormant virus in an immunocompromised patient and presents with painful localized skin rashes called as shingles. Currently, in the US, 2 doses of live attenuated varicella vaccine are available to prevent VZV infection. One of the major side effects of vaccination are the rashes. We report a unique case of vaccine induced VZV infection in a previously healthy child that presents with vesicular rashes 3 months after 1st dose of vaccination. A 16-month-old child with past medical history of premature birth at 32 weeks, presented to the pediatric outpatient clinic with complains of well-demarcated, erythematous, dry rash on both labia. Parents denied fever, cough, or any other signs and symptoms associated with rashes. patient activity level was normal and oral intake was usual. PCR testing was performed was found to be negative for Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2) and positive for VZV. Due to patient recent vaccination status, further classification of infection was needed to determine if the source of infection was wild type chicken pox or vaccine induced. A swab of one of the vesicular lesions was sent to the Ohio Department of Health, for vaccine vs wild-type strain PCR testing. The results were positive for Vaccine induced VZV infection. The patient was started on acyclovir therapy. On follow-up, the patient condition improved clinically. In pediatric populations, it is important to do extensive evaluation of rashes post vaccination as it can be occurred due to wild type, break through or it can be vaccine induced virus. Proper evaluation can significantly impact the management patients as they are maybe infectious and need to be isolated in wild type and breakthrough infection versus non-infectious in case of vaccine induced. After detailed clinical history and physical examination, it is important to investigate further through PCR testing to differentiate one category from another!

Clinical and Laboratory Characteristics of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children.

Geographical and racial factors constitute important distinctions between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C), but no study has been conducted in Vietnam. Forty-one children with KD from January 2018 to July 2020 and 42 with KD/MIS-C from August 2020 to December 2022 were included in this study. Of the patients, 52.3% were aged between 12 and 35 months. Only two were aged over 5 years, and both were belong to the KD/MIS-C group. A 59.5% of the patients were male. Apart from fever, all symptoms tended to be more frequent in patients with KD/MIS-C. The prevalence of diffuse skin rash, hand and foot edema or erythema and gastrointestinal signs was significantly higher in patients hospitalized with KD/MIS-C. There was no significant difference in laboratory findings between the two groups. Coronary artery dilation was more frequently observed in patients with KD/MIS-C compared to those with KD (40.5% vs. 14.6%, P = 0.009).

Dermatomyositis Presenting as Pseudo-angioedema

Dermatomyositis is an autoimmune inflammatory myopathy that has a heterogeneous clinical presentation, which can make it difficult to diagnose. We present the first case report of Wong-type dermatomyositis presenting with pseudo-angioedema. A 65-year-old man presented with several months of facial swelling, dysphagia, and dysarthria. The patient developed a diffuse cutaneous rash, periorbital swelling, and proximal muscle weakness. Skin biopsy was consistent with a diagnosis of Wong-type dermatomyositis.

295. SARS-CoV-2 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A): a Multicenter Case Series.

Abstract Background MIS-A frequently presents with symptoms including fevers, cardiovascular, gastrointestinal mucocutaneous, and neurologic involvement in both children and adults. Predominantly occurs in previously healthy children and young adults, disproportionately affecting individuals of African,Latino and Asian descent. Represents one of the most significant and yet under-recognized clinical consequences of SARS-CoV-2 infection. Methods A retrospective review was performed of the identified MIS-A cases admitted to two institutions between January 2020-December 2021. Included cases required evidence of present or previous SARS-CoV-2 infection by either PCR or antigen testing; and meeting the CDC definition for MIS-A. After case identification, we collected clinical and laboratory data to analyze demographics, clinical symptoms, laboratory result, imaging, length of hospitalization and therapeutic interventions. Results Ten cases were identified in the established period of time. The average interval to hospital admission was 31days. Clinical symptoms included fever, malaise, gastrointestinal complaints, dyspnea, diffuse rash. Males outnumbered females in a ratio of 7:3,with African American and Latino patients comprising 80% of the cases. All patients had elevated inflammatory markers and the most commonly manifesting organ dysfunction was cardiovascular system. Conclusion This case series helps reinforce the characterization of an as yet incompletely understood and challenging clinical syndrome, providing insight to guide diagnosis and treatment of MIS-A. A greater understanding of MIS-A may facilitate earlier syndromic recognition in order to improve outcomes, reduce unnecessary antimicrobial use, and reduce costs. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Sound Pharmaceuticals: Grant/Research Support|Trauma Insights, LLC: Advisor/Consultant.

489: CEREBRAL VASCULOPATHY-ASSOCIATED ISCHEMIC STROKE IN THE SETTING OF BACTERIAL MENINGITIS

Introduction: Bacterial Meningitis is known to have high morbidity and mortality rates. A less recognized complication from this disease includes acute ischemic stroke, which conveys a worse prognosis. Description: A 37-year-old previously healthy woman presented to the hospital with progressive encephalopathy associated with ataxia and dysarthria. Her immediate past travel history revealed a trip to Europe where she endured a COVID19 infection three weeks before her admission. Nevertheless, she recovered without any complications. However, she developed fatigue and headaches, prompting a diagnosis of post-COVID19 syndrome by her primary care physician. Over the course of several days, her ability to carry out her normal daily activities and perform work-related duties deteriorated as she developed severe fatigue accompanied by a painless diffuse skin rash. She presented to the ED once she started having symptoms of dysarthria, abasia, and truncal ataxia. An emergently obtained CSF sample was consistent with bacterial meningitis. Standard empiric antibiotics and steroids were administered. The patient’s condition acutely decompensated soon after antibiotics administration. A follow-up head CT showed global cerebral edema and hydrocephalus, triggering an EVD placement for ICP monitoring. An MRI brain showed multiple bilateral acute ischemic strokes in the brainstem and basal ganglia. A head CT angiography showed diffuse narrowing of the cerebral arteries. The patient ultimately completed a course of antibiotics (Neisseria PCR was positive). We used TCD-guided blood pressure augmentation to prevent the progression of cerebral ischemia. The patient was discharged on long-term steroid therapy for presumed post-infectious vasculopathy. A follow-up MRI brain did not reveal a progression of cerebral ischemia. Discussion: Bacterial Meningitis is a severe disease with significant complications. One such complication is ischemic stroke. However, the exact pathophysiology is unknown. Understanding the risks of developing cerebral ischemia and the related pathophysiology could help improve patient outcomes with better treatment modalities. The interplay between COVID19 infection and conventional infectious pathogens is an ongoing area of interest.