Persistent vomiting as a manifestation of coronavirus disease-2019

• Main Authors: Ballah Akawu Denue, Ngamariju Sepu
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Nigerian Journal of Medicine
• Subjects: coronavirus disease-2019; polymerase chain reaction; severe acute respiratory syndrome coronavirus – 2; vomiting
• Online Access: http://www.njmonline.org/article.asp?issn=1115-2613;year=2021;volume=30;issue=2;spage=218;epage=221;aulast=Denue

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).