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Cerebral venous thrombosis: 2 case reports In a case series of 3 patients, two patients (a 41-year-old woman and a 23-year-old man) were described, who developed central venous thrombosis (CVT) during off-label treatment with azithromycin and hydroxychloroquine for coronavirus disease 2019 (COVID-19). Additionally, in the woman, estrogen had contributed in the development of CVT [dosages and times to reactions onsets not stated; not all routes stated]. A 41-year-old woman (Case 2) was recently discharged from an outside hospital following COVID-19. She presented to the emergency department with confusion and a sudden episode of aphasia. She received off-label hydroxychloroquine and azithromycin. Her home medications included estrogen-containing oral contraceptive pills. On presentation, her BP was 107/75mm Hg, and she was afebrile. She had global aphasia and left-gaze preference, with an NIH stroke scale score of 16. Initial head CT findings were normal. CT angiography did not identify any large-vessel occlusion. On chest imaging, there was right-greater than left multifocal consolidation throughout the lungs. While waiting for a brain MRI, she developed laboured breathing. She exhibited a further decrease in the level of consciousness and had worsened neurologic examination findings, with extensor posturing to noxious stimulation. Thereafter, she was intubated and sedated. Multiplex PCR assay was negative for common pathogens causing meningitis and encephalitis. A repeat head CT-scan revealed interval development of a venous infarction in the left basal ganglia, thalamus, and mesial temporal lobe with haemorrhagic transformation, intraventricular haemorrhage and obstructive hydrocephalus. A chest-CT showed COVID-19. The CVT was probably attributed to estrogen, hydroxychloroquine and azithromycin. Additionally, role of underlying COVID-19 towards CVT development was not ruled out. A CT venogram confirmed occlusion of the internal cerebral veins with significantly reduced enhancement of the vein of Galen and distal straight sinus. Of note, her D-dimer level increased severely. An external ventricular drain was placed. Heparin infusion was started for deep CVT. However, she soon exhibited loss of brain stem reflexes. Four days post presentation, she died [immediate cause of death not stated]. A 23-year-old man (Case 3) presented with lethargy in the setting of 1-week onset of headaches, body aches, fever and dry cough. His BP was 95/53mm Hg. Multifocal pneumonia was noted on the initial chest X-ray. An RT-PCR was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A head CT-scan revealed patchy areas of low density in the bilateral cerebral hemispheres with foci of subcortical haemorrhage in the left parieto-occipital region. A CT-angiography of the head had negative findings; however, a concern for CVT was there. Investigations established a new diagnosis of diabetic ketoacidosis with new-onset diabetes mellitus. Off-label therapy with azithromycin and hydroxychloroquine were administered