Temple University Hospital, Department of Medicine.
Section of Gastroenterology and Hepatology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
Medicine (Baltimore). 2021 Apr 9;100(14):e25467. doi: 10.1097/MD.0000000000025467.
Coronavirus disease 2019 (COVID-19) is a disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which commonly presents with symptoms including fever, cough, and dyspnea. More recently, however, some patients have tested positive for COVID-19 after developing gastrointestinal (GI) symptoms either solely or in conjunction with respiratory symptoms. This may be due to SARS-CoV-2 infection of the GI tract. In patients with chronic GI illnesses, COVID-19 may initially present as a flare of their underlying GI conditions as viruses have historically been implicated in exacerbations of GI disorders, including gastroparesis.
We report a case of a 37-year-old female with a history of diabetic gastroparesis who presented to the Emergency Department (ED) with nausea and vomiting similar to her gastroparesis flares.
Her symptoms in the ED failed to improve with fluids and anti-emetic medications. After developing a fever, she was tested and found to be positive for COVID-19.
She was started on antibiotic, steroid, and antiviral medications.
Her symptoms improved, her fever defervesced on day 4 of hospitalization, and she was discharged on day 5 of hospitalization. The patient reported symptom improvement at a follow-up outpatient gastroenterology visit 2 months after hospitalization.
To the best of our knowledge, at the present time, this is the first report of a patient with COVID-19 presenting with signs and symptoms of a gastroparesis flare. This case illustrates that COVID-19 may present in an exacerbation of symptoms of an underlying disorder, such as a severe gastroparesis flare, in a patient with underlying gastroparesis. Initial presentation of these patients manifesting as a flare of their chronic GI disease, more severe than usual, should prompt an index of suspicion for COVID-19.
新型冠状病毒病 2019（COVID-19）是由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）感染引起的疾病，其常见症状包括发热、咳嗽和呼吸困难。然而，最近一些患者在出现胃肠道（GI）症状后检测出 COVID-19 呈阳性，这些症状仅表现为胃肠道症状，或者与呼吸道症状同时出现。这可能是由于 SARS-CoV-2 感染了胃肠道。在患有慢性胃肠道疾病的患者中，COVID-19 最初可能表现为其潜在胃肠道疾病的发作，因为病毒历来与胃肠道疾病的恶化有关，包括胃轻瘫。
我们报告了一例 37 岁女性患者，有糖尿病性胃轻瘫病史，因恶心和呕吐就诊于急诊科（ED），类似于胃轻瘫发作。
她在 ED 的症状未能通过补液和止吐药物改善。在出现发热后，她接受了检测，结果 COVID-19 呈阳性。
她开始接受抗生素、类固醇和抗病毒药物治疗。
她的症状改善，发热在住院第 4 天消退，在住院第 5 天出院。患者在住院后 2 个月的门诊随访时报告症状改善。
据我们所知，目前这是首例 COVID-19 患者出现胃轻瘫发作迹象和症状的报告。该病例说明 COVID-19 可能以潜在疾病症状的恶化表现出来，例如严重胃轻瘫发作，在患有潜在胃轻瘫的患者中。最初出现这些表现为慢性胃肠道疾病恶化的患者，比平时更为严重，应引起对 COVID-19 的怀疑。
