Androgen deprivation therapy for advanced prostate cancer has traditionally relied on luteinizing hormone-releasing hormone antagonists (LHRH). However, newer oral gonadotropin hormone-releasing hormone antagonists (GnRH) offer faster responses and fewer adverse effects. A 65-year-old male diabetic patient with a history of lower urinary tract symptoms and an indwelling Foley catheter for two weeks presented with respiratory difficulty, bilateral lower limb swelling, and decreased urine output. The investigation was suggestive of locally advanced prostate cancer with obstructive uropathy along with acute or chronic kidney disease. The patient was admitted to the ICU and stabilized. An urgent bedside prostate biopsy was performed. Relugolix 360 mg orally was given on the first day followed by 120 mg daily before histopathological confirmation due to impending oliguria and progressive kidney injury. Subsequent follow-up demonstrated clinical improvements, including reduced PSA and testosterone levels, confirming the efficacy of relugolix in managing advanced prostate cancer. Timely intervention and therapeutic adherence are crucial for optimal outcomes. Additionally, it highlights the preference for LHRH agonists in emergencies and the potential of oral GnRH antagonists like relugolix in prostate cancer management.

Objectives:Spina bifida occulta (SBO) is a congenital spinal defect characterised by incomplete closure of the posterior neural arch. Despite its clinical relevance, discrepancies remain in the published literature. This study aimed to determine the distribution pattern and prevalence of SBO in the Northern Indian population using three-dimensional reconstructed specimens of the lumbosacral spine. Methods:This retrospective study was conducted between March 2023 and November 2024 at the All India Institute of Medical Sciences Patna, India. A total of 241 computed tomography (CT) scans of the spine from patients aged over 18 years were analysed. Three-dimensional images were reconstructed using DICOM to Print and Geomagic Freeform Plus software to assess the presence of SBO in the lumbosacral spine. Results:SBO was identified in 48 specimens. Of these, 30 involved the S1 vertebral level, while 8 demonstrated a defect extending from S1 to S5. The overall prevalence of SBO was 19.91% (95% confidence interval: 15.18-25.64%). The defect was significantly more common in males (P = 0.042). A statistically significant association was also observed between SBO and transitional vertebrae (P = 0.00001). Conclusion:Awareness of SBO has important implications for surgical practice. A comprehensive understanding of fusion failure in the spinal column is essential for accurate diagnosis and effective treatment. This congenital defect should be carefully considered before performing caudal epidural blocks to reduce the risk of dural puncture.

ABSTRACT:Luteinizing hormone-releasing hormone agonists, used in advanced prostate cancer, can cause an initial testosterone surge and may inadequately suppress follicle-stimulating hormone, potentially promoting tumor growth. Injectable gonadotropin-releasing hormone (GnRH) antagonists avoid this surge but have drawbacks like injection-site reactions and monthly dosing. Relugolix, an oral GnRH antagonist, offers rapid testosterone suppression without flare and reduced cardiovascular risks. We report a 72-year-old man with suspected metastatic prostate cancer, presenting with severe neuritic pain and lower limb weakness. Relugolix, started before biopsy along with zoledronic acid and steroids, led to symptom relief within 24 h. This case supports Relugolix's utility in urgent hormone-sensitive metastatic prostate cancer care.

ABSTRACT:Urinary stones are a common urological condition that exhibits significant variability in prevalence, clinical presentation, and composition across different geographic regions. In India, the condition affects approximately 2 million individuals annually, with notable regional differences driven by dietary habits, environmental factors, and socioeconomic conditions. This study comprehensively reviews the clinical characteristics, urinary stone composition, and associated risk factors in India while comparing these findings with global trends. The data for this review were obtained through an extensive analysis of the available literature on urinary stone composition and clinical characteristics in India and various countries worldwide. Sources included multiple databases such as Springer, Scopus, Elsevier, Google Scholar, Wiley, Web of Science, PubMed, and Taylor and Francis. The data were synthesized to assess the prevalence, composition, and risk factors of urinary stones by region, and these were compared with international data. Mixed stones were more commonly observed in northern and coastal regions, while uric acid (UA) stones showed a higher prevalence in the southern states. Globally, calcium oxalate (CaOx) remained the dominant stone type, but certain regions exhibited a higher occurrence of struvite and UA stones, largely attributed to specific dietary patterns and infection rates. The study concludes that urinary stone composition in India varies regionally due to dietary habits, hydration, and environmental factors. While CaOx remains prevalent globally, other stone types show distinct regional differences. Targeted prevention through hydration and dietary modifications is crucial, and future research should explore genetic predispositions and the impact of climate change on stone formation.

Pseudoaneurysm is a common vascular abnormality marked by arterial wall disruption, with complications that can arise unpredictably and carry high morbidity and mortality rates. This case study emphasises the management of recurrent haematuria and clot retention in a young man presenting to the emergency department. It underscores the importance of early recognition and management of recurrent haematuria and clot retention caused by pseudoaneurysm, emphasising the critical role of multidisciplinary collaboration in optimising patient outcomes.

In this case study, a young male presented with recurrent right flank pain and hematuria. Further investigations revealed an upper ureteric stone, causing significant hydronephrosis and blood accumulation within the pelvicalyceal system. Remarkably, blood clots were observed in this system alongside the ureteric calculus. The medical team opted for standard percutaneous nephrolithotomy (PCNL) to address the stone and simultaneously remove the clots. Additionally, a DJ stent was placed to ensure proper drainage and prevent complications. This rare presentation emphasizes the importance of recognizing diverse manifestations of ureteric stones and timely intervention through PCNL for effective management.

OBJECTIVES:To assess the proportion and pattern of injury of the anterolateral ligament (ALL) and the Kaplan fibre (KF) complex in knees with anterior cruciate ligament (ACL) injuries on MRI using three-dimensional (3D) proton density (PD) sequences.METHODS:A total of 88 patients having ACL injury were included in this cross-sectional study. 3D PD sequences were used to assess injury of ALL and the KF complex and were graded on a scale of 0 to 3. MR images were evaluated by two radiologists. Interobserver agreement was determined using Cohen Kappa.RESULTS:Femoral, meniscal, and tibial portions of ALL were visualized in 90.9%, 92%, and 94.3% of the study subjects, respectively. Proximal and distal KF were visualized in 92% and 93.2% of patients, respectively. Injury to ALL and KF was seen in 63.6% and 17% of the patients, respectively. Excellent interobserver agreement was noted for the identification and grading of ALL and KF complex injuries.CONCLUSIONS:Oblique reformatted 3DPD MRI reliably detect ALC; however, ALL injury is better characterized than KF injury using this sequence.ADVANCES IN KNOWLEDGE:Given the potential role of anterolateral complex (ALC) in maintaining the rotational stability of the knee, ALC assessment using the 3D PD sequences and their oblique reformatted images should be incorporated as routine review area of the knee MRI, particularly in the setting of ACL tear.

Background and objective Urinary stones are a prevalent medical condition entailing significant health burdens and substantial financial ramifications. Its global prevalence is expected to rise notably, particularly in low-middle-income nations. Understanding the spectrum of diverse urinary stone types is crucial for effective management and prevention. This study aims to elucidate the demographic profiles, clinical types, and recurrence of urinary stone cases at a tertiary care hospital in Eastern India. Methods and materials The clinical data from the electronic medical record of 1,231 patients with urolithiasis who underwent surgery in a tertiary care center in eastern India from January 2015 to November 2022 were retrospectively analyzed. Patient data, including demographic information, clinical records, dietary habits, water intake, and stone recurrence history, were collected. A thorough statistical analysis was conducted to elucidate the associations between patient characteristics, urinary stone composition, and recurrence. Results Among the 1,231 participants, the majority of cases (343 (27.9%)) were in the 31-40 age group, with a higher prevalence in males (876 (71.2%)) than in females (355 (28.8%)). Flank pain or abdominal pain (593 (48.1%)) was the primary complaint, followed by nausea/vomiting (227 (18.5%)). Most stones (922 (74.9%)) were located in the kidney, and calcium oxalate was the predominant stone component (773 (62.8%)). The highest stone recurrence rates were in patients aged between 21-30 years (21 (36.8%)) and 31-40 years (16 (28.0%)). A low non-vegetarian diet and adequate hydration may reduce the likelihood of stone recurrences. Conclusion This study provides insights into the compositional analysis of urinary stones in the eastern Indian population, addressing the causes of their recurrence and management strategies, which are crucial for prevention and effective management. The findings indicate that the early middle-aged group exhibited the highest incidence of urinary stones. We also observed that strict adherence to a low animal protein, along with proper hydration and lifestyle changes, significantly reduced urinary stone recurrence.

Although studies of the sacral corridor dimension have been reported in the European population, little attention has been paid to this issue in the Asian population. The purpose of the study is to estimate the safe dimension of the corridor to avoid neurovascular damage during the fixation of the sacral fracture. The study aimed to examine the cephalocaudal (vertical) and the anteroposterior diameter of the bony passage in the upper three sacral segments. The study further examines the effect of age and sex on corridor dimensions at different sacral levels. Three-dimensionally reconstructed sacra from computed tomography of normal subjects were included in the study. Cephalocaudal and anteroposterior diameters were measured in coronal and axial sections using Geomagic Freeform Plus software. Anteroposterior diameter of the sacral corridor at the first, second, and third sacral segments are significantly higher in males (P=0.013, 0.0011, and <0.0001, respectively). The length of the sacrum also revealed sexual dimorphism (P<0.00016). The anteroposterior diameter of the second sacral segment (ap-S2c) correlated moderately with the first sacral anteroposterior diameter (ap-S1c) (R=0.519, P<0.001). The ap-S2c exhibited a moderate correlation to the third sacral segment (ap-S3c) (R=0.677, P<0.001). The sacral corridor at the level of S1 has the largest cephalocaudal (18.25 mm) and anteroposterior diameter (17.11 mm). Placement of the screw in the first sacral corridor may avoid damage to the neurovascular bundle during the fixation of the sacral fracture.

INTRODUCTION:The evolving curricula in medical education have significantly reduced the time allocated for learning and clinically correlating anatomical facts. This has led to noticeable gaps in the anatomical knowledge observed by specialists while training junior residents and is being extensively documented in the literature. MATERIALS AND METHODS:The descriptive, cross-sectional, questionnaire-based study was conducted online by sharing the questionnaire via e-mail, WhatsApp, and Telegram to institutes across all Indian states and union territories where postgraduate radiodiagnosis courses are offered. RESULTS:The survey had a predominant response from radiodiagnosis residents belonging to the female gender (53.8%), pursuing MD (83.2%), from final year (43.4%), and from private (58%) institutes. 98% of the residents encountered challenges interpreting radiological images, 89% had no formal training in anatomy during residency, and 59% felt a lack of confidence regarding the human anatomy knowledge required for radiodiagnosis. 91.5% of the residents believe that a short human anatomy posting would significantly improve their radiological reporting skills, and 94% expressed interest in attending workshops or seminars to enhance their knowledge of human anatomy for radiological practice. A standardized curriculum for human anatomy training during the radiodiagnosis residency program is needed for the current period, as 90% of the respondents agreed. CONCLUSION:To bolster future radiologists' diagnostic acumen, an enhanced anatomical education within radiodiagnosis residency programs in India is indeed necessary. Implementing structured training programs, incorporating interactive workshops, and leveraging advanced technological tools can significantly bridge knowledge gaps among residents.

Lipofibromatosis is an extremely rare, hamartomatous soft-tissue tumor seen almost exclusively in the pediatric age group. They are typically found in the extremities. Varied clinical presentations and lack of specificity in imaging findings often create a diagnostic dilemma. A systematic approach with emphasis on tumor composition is needed to arrive at a correct diagnosis. We report an unusual case of a giant lipofibromatosis that presented as a painless progressive back swelling in a 10-month-old male infant.

Abstract Background Fistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano. Material and methods We enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically. Results At 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy. Conclusion Ligation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant.

Objectives: The aim of the study was to evaluate the stiffness of cervix and determine its significance in predicting successful outcome of induction of labour. The primary objective was to determine the differences in elastography indices of different areas of cervix between the outcome groups of successful and failed induction of labour. A secondary objective was to find out the correlation of these elastography indices with Bishop’s score and cervical length. Methods: This was a prospective, observational study conducted over a period of 6 months on pregnant women admitted in the labour room for induction of labour. Establishment of adequate regular uterine contractions – at least three contractions lasting 40–45 s in a 10-min period – was taken as end point for successful outcome of induction of labour. Even after 24 h of initiation of induction of labour, regular, adequate and painful uterine contractions were not established, then induction of labour was described as having failed. Prior to induction, cervical length measurement, Bishop’s scoring and elastographic evaluation of the cervix were done by stress–strain elastography. A colour map was produced from purple to red and a five-step scale – the elastography index – was used to describe the various parts of the cervix. The differences between elastography indices of different parts of cervix were estimated using Mann–Whitney U test. Correlation of the indices with cervical length and Bishop’s score was determined by Spearman’s correlation coefficient. Results: A total of 64 women were included in the study. A significant difference ( p < 0.001) was found in the elastography index of internal os between the two outcome groups of success (1.76 ± 0.64) and failure (0.54 ± 0.18). However, the elastography index of central cervical canal, external os, anterior lip and posterior lips did not differ significantly across the outcome groups. A significant positive correlation was found between elastography index of internal os and cervical length (Spearman’s correlation coefficient, r = 0.441, p < 0.001) and between elastography index of external os and cervical length ( r = 0.347, p = 0.005), whereas a negative correlation was seen between elastography index of external os and Bishop’s score ( r = −0.270, p = 0.031). Conclusion: Elastography index of internal os can be used to predict outcome of induction of labour. Cervical elastography is a promising new technique for cervical consistency assessment. Further larger studies are required to determine some cut-off point for elastography index of internal os in prediction of outcome of induction of labour and to strongly establish the usefulness of cervical elastography for pregnancy management, preventing preterm delivery and establishment of cut-off points to determine successful induction.

Abstract Objective Urinary stones are typical conditions that result in significant morbidity and monetary costs. Analysis of patients with different stones determines the preferred treatment modality and helps decide the preventive measures to avoid stone recurrence. This study aimed to identify the association between patient characteristics with stone type and composition in the eastern region of India. Material and methods A super specialty hospital in an eastern Indian city enrolled 1231 cases of urinary stones which were admitted for elective stone removal between January 2015 and November 2022. Patient information was gathered, including demographics, clinical data, dietary habits, water consumption, geographic region, and stone recurrence. An analysis was performed to establish a relationship between these characteristics and the type and composition of stones. Result The study found that urinary stones are more common in men, with calcium oxalate being the most prevalent type of stone. Individuals aged 31–40 had the highest incidence of stones, including double-component stones, while single-component and multiple-component stones were most common in those aged 21–30. The kidneys were found to be the most likely origin of stones and the instances of stone recurrence showed a substantial (p = < 0.001) correlation with dietary habits and water intake. Conclusion Calcium oxalate is the predominant stone component. The stone recurrence rate factors are correlated with age, gender, food habits, and water intake patterns.

Normal development of the fetal kidneys and adrenal glands is essential for a good crucial neonatal outcome. There is, however, paucity of data on normal fetal adrenal gland and renal length in populations of North India and this poses a not infrequent dilemma when an anomaly is suspected during the anomaly scan. The objective of this study was to obtain gestation wise data of fetal renal length and adrenal length for 18, 19, 20 and 21 weeks of gestation and construct a gestation age wise size chart. This was a cross sectional study of 128 consecutive normal pregnancies after exclusion of multiple gestations, maternal complications, congenital anomalies and a family history of congenial adrenal hyperplasia. Gestational age of the fetus was calculated from fetal biometry. Measurements were made in the sagittal plane as length including renal and adrenal, longest pole to pole length of kidney and adrenal gland length calculated as the difference between the values. The values were analysed to yield the 95% confidence interval along with the 50th centile for gestational age groups of 18–21 weeks.

Abstract Pritanjali Singh Background  Wilms' tumor (WT) is the most common kidney tumor of the pediatric age group. The outcome of WT has improved due to the evolution of the treatment approach. A prospective observational study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, to analyze the clinical profile along with the response and outcome to neoadjuvant chemotherapy according to the International Society of Pediatric Oncology (SIOP) protocol. Materials and Methods  In total, 28 patients of WT visited the radiotherapy department from January 2015 to December 2019. Results  Gender distribution showed male preponderance with a median age at diagnosis was 31 months. The abdominal lump was the dominant clinical presentation. The median volume of tumor at diagnosis was 359.48 mL (52.67–1805.76). Radiological staging workup shows that stage I, II, III, IV, and V were 7.1%, 39.3%, 39.3%, 10.7%, and 3.6% respectively. Neoadjuvant chemotherapy (NACT) was received by all patients. Also, 71.4% of patients showed > 50% of tumor volume reduction, while 28.6% of patients showed < 50% of tumor mass reduction. There was a statistically significant decrease in the tumor volume reduction following neoadjuvant chemotherapy ( p  < 0.001). There was a statistically significant stage down ( p  = 0.018) of the disease. Bivariate correlation studies showed recurrence was correlating statistically significantly with age < 24 months ( p  = 0.049), locoregional lymph nodes ( p  = 0.008), histopathological subtypes ( p  < 0.001), stage of the disease ( p  = 0.003), and risk groups ( p  < 0.001). In addition, 25% of patients developed recurrence during the median follow-up of 25 months. The median disease-free survival (DFS) and overall survival (OS) were not reached. The mean DFS and OS were 48 and 59.13 months, respectively. One- and 3-year DFS were 100% and 64.1%, respectively. One- and 3-year OS were 100% and 75% respectively. Conclusion  Our study suggests that most of the patients presented at an advanced stage, thus rendering most of the cases difficult to undergo surgery at presentation. Neoadjuvant chemotherapy followed by surgery may be considered a well-balanced approach with a comparable response and survival outcomes.

BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs). AIM To describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis. METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher's exact tests and Mann-Whitney U test were used for statistical analysis (P < 0.05). RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis (P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG. CONCLUSION A multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG.

Background: Stroke is primarily a clinical diagnosis. It can be hemorrhagic or ischemic in etiology. Computed tomography (CT) brain is usually the initial investigation in most patients with suspected stroke. Although it has excellent accuracy in diagnosing hemorrhage, ischemic changes may not be apparent in the first few hours. Some centers use focused magnetic resonance imaging (MRI) studies to help in selecting appropriate patients for reperfusion therapy. However, clinicians often use this investigation even when reperfusion therapy is not being considered. This study aims to find out whether doing an MRI in addition to a CT scan has any clinical utility in this situation. Primary Objective: To determine the proportion of patients who undergo a change in their management based on MRI findings. Secondary Objectives: 1. To determine the time duration from the onset of symptoms to presentation at the hospital. 2. To determine the time duration from presentation to the hospital to get CT performed. 3. To determine the proportion of patients who had MRI in addition to CT. 4. To determine the time duration from CT performed to MRI performed. Materials and Methods: Study Design: Retrospective, descriptive observational study. Inclusion Criteria: Patients above age 18 admitted at a tertiary hospital with a clinical diagnosis of stroke between 1/8/2018 and 30/7/2019. Exclusion Criteria: Patients who had already undergone MRI before presentation to the hospital and patients undergoing thrombolysis. Patients meeting the inclusion and exclusion criteria were identified from the hospital information system and the ward admission register and by manual examination of the patients' case notes. Relevant data were obtained from the case notes and collected on a google form and downloaded in Microsoft Excel 2019. SPSS version 22 was used for data analysis. Results: Out of the 106 patients, 54% (n = 57) were diagnosed as having ischemic stroke, whereas 46% (n = 49) were diagnosed with hemorrhagic stroke after initial assessment and CT scan. Only 2.8% (n = 3) of the patients presented within 4.5 hours of the onset of symptoms. 43.4% (n = 46) presented between 4.5 and 24 hours from the onset, whereas 53.8% (n = 57) presented more than 24 hours after the onset. Twenty-seven patients had their CT scan performed prior to their presentation at the center. For the remaining 79, the median time from presentation to CT scanning was 2 ± 1.5 hours. 24.5% (n = 26) of all patients had an MRI performed in addition to the CT scan. There was wide variation in the time from CT scanning to the MRI. Among the patients who had an MRI, additional information was obtained by the investigation in 58% (n = 15). However, this led to a change in management in only three (11.5%) of the patients. On review, it was found that the change was justified in only two patients. Furthermore, one patient who was diagnosed with tuberculoma had a long history of fever which was missed on initial evaluation. Considering these, MRI can be credited for a meaningful change in management in only 4% (n = 1) of the cases. Conclusion: The findings of this study do not support the routine use of MRI in patients who are not candidates for reperfusion therapy. Their use should be restricted to cases where some specific information is sought or where there is diagnostic uncertainty. Allocation of resources in developing integrated acute stroke pathways is likely to give a better value for money.

Rationale: The mechanism of sudden cardiac death in COVID-19 can be multifactorial. Cardiac hypersensitivity to 5-ASA therapy leading to myocarditis has been reported in some cases. Cytokine storm syndrome and idiosyncratic reaction with mesalazine use may lead to sudden cardiac death in COVID-19. Use of immunosuppressants in hospitalized COVID-19 patients should be continued with caution, especially in patients with inflammatory bowel disease. Patient's concern: A 75-year-old man who was tested positive for SARS-CoV-2 was admitted with a history of shortness of breath for the last two days. He was a known case of Crohn's disease treated with mesalazine. Diagnosis: COVID-19 pneumonia with underlying Crohn's disease leading to sudden cardiac death. Intervention: Remdesivir, antibiotics, steroids, low molecular weight heparin, tablet zinc, tab vitamin C, and other supportive treatment were started. Because of increased inflammatory markers, itolizumab was given to the patient on the 2nd day. Outcome: On the 5th day of the intensive care unit, the patient complained of sudden chest pain with respiratory distress leading to bradycardia and asystole and could not be resuscitated. Lessons: Causes for sudden cardiac death in COVID- 19 pneumonia patients with Crohn's disease is multifactorial. Although mesalazine may be a safe and effective drug in the management of inflammatory bowel disease, it can induce sytokine strom syndrome and idiosyncratic reactions that could be one of the reasons of sudden cardic death. Therefore, we should be aware of its serious and potentially life-threatening complications, especially in COVID19 infected patients.