Cao Can, Lakshminarayanan Renuka, McCracken John, Lai Jinping
The Warren Alpert Medical School, Brown University, Providence, RI, USA.
Department of Pathology and Laboratory Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA.
Gastroenterology Res. 2021 Feb;14(1):41-44. doi: 10.14740/gr1353. Epub 2021 Feb 19.
While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.
虽然2019冠状病毒病（COVID-19）因可导致严重的下呼吸道症状而广为人知，但最近的文献记录了许多多系统受累的病例，这些病例可能表现为非典型症状。我们报告一例83岁男性病例，他在接受腹主动脉瘤修复术后因结肠损伤而康复，结肠损伤需要进行结肠造口术，这使他3年来一直依赖胃造口管喂养。该患者从一家护理机构转至急诊科，出现精神状态改变、发热和黄疸。腹部影像学检查和活检最终确定为十二指肠炎症和壶腹炎症，并伴有疑似肝门部胆管癌导致胆管梗阻、脓毒症和肝性脑病。COVID-19聚合酶链反应（PCR）检测呈阳性。尽管初始表现严重，但患者入院时无呼吸道症状，胸部X线检查结果也无异常，且在病程后期才出现缺氧。因此，本病例报告了一例COVID-19初始表现异常，伴有胃肠道和肝胆系统受累导致肝性脑病，但无肺部表现，强调了在COVID-19阳性患者中，无论有无肺部症状，都要对肺外病变进行检查的重要性。
