Introduction:

Gastrointestinal (GI) symptom is one of COVID-19 manifestations that was rarely documented as a chief complaint but has started to be commonly reported lately. Here we present a case of a 42-year-old female with GI symptom as her chief complaint which eventually aggravated into respiratory and systemic manifestations requiring vasopressor support.

The patient came with abdominal pain in the epigastric area for 3 days along with nausea, vomiting, and low-grade fever. Blood analysis revealed leukocytosis and neutrophilia meanwhile, urinalysis showed +2 bacteria. She was admitted to the hospital with GERD and bacterial infection. One day after the admission, she developed dyspnea and crackles with oxygen saturation of 95% and blood pressure of 80/50 mmHg. Her chest x-ray fit the characteristics of pneumonia.

On day 3, her symptoms worsened so she was immediately transferred to the isolation room with close monitoring and dopamine drip. The diagnosis of COVID-19 was confirmed by PCR through a nasopharyngeal specimen. She was given levofloxacin, oseltamivir, chloroquine, vitamin C, and symptomatic treatments. On day 5, her blood pressure stabilized, hence the dopamine was stopped. On day 17 the patient was discharged as her symptoms had completely relieved. The second PCR was done on day 13 and the result was negative.

Conclusion

GI symptoms can occur in COVID-19 patients without respiratory manifestation because ACE2 receptors are expresses in the GI tract. Special precautions for COVID-19 need to be taken by health professionals in treating patients with GI complaints.

Keywords

Gastrointestinal symptoms, GERD, COVID-19, vasopressor support