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INTRODUCTION AND IMPORTANCE: Herein, we present an unexpected rectus sheath hematoma (RSH) complication due to chronic COVID-19 related cough and prolonged anticoagulation therapy. COVID-19 usually presents with respiratory symptoms, such as cough. Anticoagulants are used in severe cases of COVID-19 as well as in mechanical heart valve replacement to prevent thrombosis. However, there is a high risk of bleeding. CASE PRESENTATION: We report a rare case of a 74-year-old woman who presented with a COVID-19 related cough persistent over two months, and was also undertaking warfarin daily for 10 years due to mechanical mitral valve replacement. Computed Tomography (CT) scan revealed retroperitoneal and rectus sheath hematoma (RSH) as well as rectus abdominis muscle rupture. She had hemorrhagic shock due to rapid hematoma expansion to the right and left flank as well as to the back. Thus, she required an emergency surgery in which the hematoma was excised and the rectus abdominis muscle was sutured. The patient was discharged and has completely recovered. CLINICAL DISCUSSION: Many factors and mechanisms contribute to the formation of the RSH and the rupture of rectus abdominis muscle, including severe cough and anticoagulants. CONCLUSION: Although the use of anticoagulants is necessary for patients who underwent mechanical valve replacement or for COVID-19 patients as a prophylaxis of thrombotic complication, RSH should be kept in mind and carefully monitored as it may require surgical intervention in severe cases.
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Dermoid cysts are a rare case of developmental abnormality that results in benign tumors, which are classified into three categories based on their cause and appearance. Dermoid cysts tend to present within the first year after birth and are most commonly diagnosed by the age of 5. A 15-year-old girl presented with a complaint of localized, paroxysmal pain and malodorous fluid oozing from the left shoulder for the last 2 weeks. A fistulogram showed an extension of the fistula behind the clavicle and above the scapula with a cystic formation measuring ~2 cm on the upper part of the fistula tract, which called for appropriate surgical intervention. Our case is the first reported dermoid cyst in the left shoulder area associated with a fistula at birth, which is a rare complication since the complications of dermoid cysts differ depending on their location and size.