Persistent Vomiting as a Manifestation of Coronavirus Disease‑2019

Abstract

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2. It often manifest with respiratory symptoms such as cough, fever, and difficulty in breathing. In addition to pulmonary involvement, COVID-19 is also associated with several extrapulmonary manifestations. The extrapulmonary pathology of COVID‑19 could be due to either extrapulmonary  dissemination of the virus and its replication, as has been observed for other zoonotic coronaviruses or widespread immunopathological complications of the disease. We report a case of an 18-year-old female who presented with persistent vomiting
as the only presentation of COVID-19. Clinical evaluation including a battery of investigation such as hematological, biochemical,
imaging, and endoscopy did not reveal any abnormality. However, her nasopharyngeal and nasal swab samples tested positive for
SARS-CoV-2 by polymerase chain reaction (PCR). We placed her on the approved COVID-19 regimen comprising lopinavir/ritonavir,
zinc sulfate, hydroxychloroquine and azithromycin with augmentin, vitamin C, metoclopramide and intravenous fluid for one week.
The vomiting subsided within 48-h of commencing the medications, and she became asymptomatic after 72-h. Repeat PCR after 12 days returned negative for SARS-CoV-2. This case report highlights the unusual clinical feature of COVID-19. It, therefore, underscores the need to thoroughly investigate symptomatic patients and also to optimize standard precaution as potentially infectious diseases such as COVID-19 may “masquerade” as a vague constitutional symptom(s).

Keywords: Coronavirus disease-2019, polymerase chain reaction, severe acute respiratory syndrome coronavirus – 2, vomiting