Background. Coronavirus Disease 2019 (Covid-19) is expanding worldwide. Although it seems to be a purely respiratory disease, occasional reports of lesions in other organs have been published. We report here an asymptomatic child Covid-19 patient with the main symptom of abdominal pain distension and without any respiratory symptoms.
Case presentation. A 14 year-old male patient without respiratory involvement but with main complaints of fever, malaise, anorexia, and severe abdominal pain was admitted to a hospital in Mashhad, Iran. Following general anaesthesia, laparotomy revealed distension of the small intestine and an adhesive ileo-caecal band that had produced ileum herniation without free fluid in the abdomen. The band was surgically severed and the patient referred to the recovery room. Because of pulse rate of 36-40 per min and respiratory rate of 140 and a saturated O2 of 86%, the patient was referred to the intensive care unit. Chest X-ray and high-resolution computed tomography of the lungs showed bilateral, diffuse, peripheral dense areas of ground-glass appearance. A nasopharyngeal swab for Covid-19 diagnosis, ordered due to lymphopenia together with these diffuse lung infiltrations, showed a positive result. This led to drug treatment with lopinavir/ritonavir, hydroxychloroquine, ribavirin/oseltamivir and meropenem. The patient was febrile and developed tachycardia on the third day accompanied with a respiratory rate of 44/min. At this point, tracheal intubation was done but the patient died after 3 hours due to cardiac arrest.
Conclusions. The case report brings forth the hypothesis that the gastrointestinal manifestation may be untypical symptoms of Covid-19 infection, and highlights the importance for the diagnosis to be based on combined laboratory-based data and scanning imagery.