Rita Rehana, MD1, Rahim Jiwani, MD2; 1Henry Ford Macomb Hospital, Clinton Township, MI; 2East Carolina University, Greenville, NC
Introduction: The outbreak of contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially reported in Wuhan, China in late 2019 and has rapidly spread. Many cases of respiratory illness reported involving novel coronavirus (COVID-19). Patients present with most commonly fever, malaise, myalgia, cough. Other clinical symptoms include gastrointestinal (GI) dysfunction such as nausea, diarrhea and transaminitis. This causes concern for fecal shedding since the viral nucleic acid is detected in stool. Also, SARS-CoV-2 can up-regulate human angiotensin converting enzyme 2 receptors within liver tissue causing acute liver damage. SARS-CoV-2 also causes GI damage through activation of inflammatory responses. We present a case of COVID-19 who initially presented with GI symptoms.
Methods: A 52 year old male with history of chronic kidney disease, hypertension presented for fevers, chills, nausea, and diarrhea. Initially he had intermittent nausea for 2 weeks, then developed fevers and chills over 4-5 days. He had associated dyspnea, cough, generalized abdominal pain and diarrhea. He denied travel or sick contacts in the community, however worked in healthcare. On presentation, he was febrile with course breath sounds in bilateral lung fields. Bloodwork showed lymphopenia, transaminitis, elevated ferritin. He became a high-risk person under investigation for COVID-19 given his clinical picture, persistent fevers and occupational exposure. COVID-19 swab resulted negative, but due to high clinical suspicion, COVID-19 was restested which returned positive. He developed acute on chronic renal failure requiring dialysis and worsening liver function. On day 3, he sustained hypoxia and developed ARDS. Despite intubation he was unable to adequately oxygenate. Discussion: Clinicians need to be aware that typical flu symptoms may not be the only clinical presentation COVID-19. GI dysfunction, specifically nausea and/or diarrhea, can be a presenting feature of COVID-19. Therefore, in the absence of respiratory symptoms, we should raise an index for suspicion in patients who present with GI manifestations. Patients presenting with GI symptoms tend to have poorer prognosis. Testing for the virus in stool for these patients may be beneficial. Cognisance can allow for earlier detection of COVID-19, establishing isolation, thereby minimizing transmission. Further clinical research needs to be determined regarding the outcomes of digestive symptoms in patients infected with COVID-19.
Temperature trend every 4 hours during hospitalization
Disclosures: Rita Rehana indicated no relevant financial relationships. Rahim Jiwani indicated no relevant financial relationships.