Karın ağrısı COVID-19'un tek şikayeti olabilir; olgu sunumu ve güncel literatürün gözden geçirilmesi

Abstract

Amaç: Yeni koronavirüs dünya çapında hızla yayılmış ve uluslararası bir pandemiye neden olmuştur. Ateş, öksürük ve nefes darlığı COVID-19'un (koronavirüs hastalığı 2019) karakteristik belirtileri olarak kabul edilmektedir. Gastrointestinal semptomlar daha az görülmesine rağmen, büyük ölçüde göz ardı edilen semptomlar arasındadır. Bu olgu sunumunda acil servise sadece karın ağrısı ile başvuran bir erkek hastayı sunmayı amaçladık. Olgu sunumu: 70 yaşında erkek hasta, dört gündür olan karın ağrısı şikayeti ile acil servise başvurdu. Hastanın karın ağrısı göbek çevresinde ve kolik vasıflı idi. Batın muayenesinde göbek çevresinde yaygın hassasiyet olan hastanın defans veya ribaundu yoktu. Hastanın abdominal BT’si (bilgisayarlı tomografi) normal olarak değerlendirildi. Ancak abdominal BT'de, akciğer bazalinde COVID-19 için tipik BT bulguları mevcuttu. Yatış sırasındaki ilk RT-PCR (gerçek zamanlı ters transkripsiyon polimeraz zincir reaksiyonu) testi negatif olan hastanın 48 saat sonraki testi pozitifti. Sonuç: Çalışmamız, hekimlerinin COVID-19'un atipik prezentasyonları konusunda tetikte olması gerektiğini vurgulamaktadır.

Keywords

• COVID19
• abdominal ağrı
• gastrointestinal
• atipik prezentasyon

Abdominal pain may be the only complaint of COVID-19; case report and review of the current literature

Abstract

Aim: The new coronavirus spread rapidly around the world, causing an international emergency pandemic. Fever, dry cough, and shortness of breath are considered the characteristic signs of COVID-19 (coronavirus disease 2019). Although gastrointestinal symptoms are less common, they are among the symptoms of COVID-19 that are largely ignored. In this case report, we aimed to present a male patient who applied to the emergency department with only abdominal pain. Case report: A 70-year-old male patient was admitted to the emergency department with a complaint of abdominal pain four days prior. The patient had abdominal pain that had been around the umbilicus and colic for the previous four days. Abdominal examination showed widespread tenderness around the umbilicus but no defences or rebounds. The abdominal CT (computed tomography) results were considered normal. But on the abdominal CT, there were typical CT findings on the lung base for COVID-19. The RT-PCR (real-time reverse transcription-polymerase chain reaction) tests at admission and 48 hours later were negative and positive, respectively. Conclusion: Our study emphasizes that physicians should be alert to atypical presentations of COVID-19.

Keywords

• COVID19
• Abdominal Pain
• gastrointestinal
• atypical presentation

References

1. 1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl. 2020 28;395(10229):1054–62.
2. 2. World Health Organization [Internet]. COVID-19 Weekly Epidemiological Update-16 February 2021 [cited 2021 Feb 20].
3. 3. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention - UpToDate [Internet]. [cited 2020 May 3]. Available from: https://www.uptodate.com
4. 4. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. JAMA. 2020 Mar 17;323(11):1061-1069.
5. 5. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet Lond Engl. 2020 15;395(10223):507–13. 6. Nguyen S, Major K, Cochet C, et al. COVID-19 infection in the elderly in Frenchspeaking Switzerland: an inventory of beliefs, convictions and certainties [Internet]. Rev Med Suisse 2020 ; 16 : 835-8
6. 7. Kim J, Thomsen T, Sell N, Goldsmith AJ. Abdominal and testicular pain: An atypical presentation of COVID-19. Am J Emerg Med. 2020;38(7):1542.e1-1542.e3.
7. 8. Gao QY, Chen YX, Fang JY. 2019 Novel coronavirus infection and gastrointestinal tract. J Dig Dis. 2020 Mar;21(3):125–6.
8. 9. Pan L, Mu M, Yang P, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020 May;115(5):766-773.

9. 10. Sellevoll HB, Saeed U, Young VS, et al. Acute abdomen as an early symptom of COVID-19. Tidsskr Nor Laegeforen. 2020 Mar 31;140(7). English, Norwegian.
10. 11. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-1720
11. 12. Dane B, Brusca-Augello G, Kim D, Katz DS. Unexpected Findings of Coronavirus Disease (COVID-19) at the Lung Bases on Abdominopelvic CT. AJR Am J Roentgenol. 2020 April 22;1–4.
12. 13. Michelen M, Jones N, Stavropoulou C. In patients of COVID-19, what are the symptoms and clinical features of mild and moderate cases? [Internet]. The Centre for Evidence-Based Medicine CEBM. [cited 2020 Apr 27].
13. 14. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 February 26;200642.