S3020 COVID-19 Manifesting as a Gastroparesis Flare: A Case Report

Autor: Rajiv Bhuta, Kamal Baig, Henry P. Parkman, Zubair Malik, Jun H. Song
Rok vydání: 2020
Předmět:
Zdroj: American Journal of Gastroenterology. 115:S1591-S1591
ISSN: 1572-0241
0002-9270
DOI: 10.14309/01.ajg.0000714128.99414.78
Popis: INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a disease caused by infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Though COVID-19 commonly presents with pulmonary manifestations, some patients have presented with gastrointestinal (GI) symptoms This may be due to SARS-CoV-2 infection of the GI tract The predilection of SARS-CoV- 2 for either the pulmonary system or the GI tract is not well understood, although both systems express the SARS-CoV-2 ACE2 protein cell receptor It is also possible that comorbidities may play a role in patients' susceptibility to developing COVID-19 CASE DESCRIPTION/METHODS: We report a case of a 37 year-old female with diabetic gastroparesis who presented with 2 days of intractable nausea and vomiting more severe than her baseline gastroparesis symptoms Review of systems was negative for fevers or respiratory symptoms After developing a fever in the hospital, she was tested for COVID-19 with a nasopharyngeal swab (NS) CT chest (Figure 1) showed multi-focal ground glass opacities and was designated as a category 1, defined as imaging consistent with a multifocal viral pneumonia On day 2, the gastroenterology service was consulted and recommended starting pantoprazole, ondansetron, metoclopramide, and mirtazapine During this time, the NS returned positive for SARS-CoV-2 RNA She was started on antibiotics, steroids, and Remdesivir Her aspartate aminotransferase (AST) values from days 1 to 4 were 21, 21, 40, and 50 U/L, respectively (normal: 15-37 U/L) She became afebrile by day 4, her GI symptoms improved, and she was discharged on day 5 DISCUSSION: COVID-19 presents primarily with respiratory symptoms such as cough and dyspnea Chronic pulmonary comorbidities may increase the risk of acquiring SARS-CoV-2 infection of the pulmonary system In our patient, her severe gastroparesis symptoms and uptrending AST values suggest SARS-CoV-2 infection of the GI tract Though it is possible that her symptoms were independent of her gastroparesis, perhaps due to the SARS-CoV-2 infection itself, an exacerbation of gastroparesis from the SARS-CoV-2 is the most likely scenario as viruses have been implicated in the pathogenesis of gastroparesis She may have been predisposed to this infection due to her underlying gastroparesis This unique case illustrates that in patients presenting with an exacerbation of a chronic GI disease, such as gastroparesis, one should consider COVID-19 as a potential etiology for the worsening of previously stable symptoms
Databáze: OpenAIRE
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