Top 10: June 28

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By Christian Hoffmann &
Bernd S. Kamps

28 June

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Anything goes

Here we present the best or weirdest (depending on your point of view) case reports on COVID-19 published in the first 6 months. Focus of this first issue will be gastrointestinal manifestations…

Prince G, Sergel M. Persistent hiccups as an atypical presenting complaint of COVID-19. Am J Emerg Med. 2020 Apr 18:S0735-6757(20)30274-6. PubMed: . Full-text:


Believe it or not: COVID-19 may atypically present as persistent hiccups for four days (62 year old man, Chicago).

Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L. Can COVID 19 present like appendicitis? Version 2. IDCases. 2020 Jun 2;21:e00860. PubMed: . Full-text: eCollection 2020


And yes, of course, as appendicitis, the abdominal chameleon (40 year old woman, Quatar).

Gulen M, Satar S. Uncommon presentation of COVID-19: Gastrointestinal bleeding. Clin Res Hepatol Gastroenterol. 2020 May 21:S2210-7401(20)30139-X. PubMed: . Full-text:

In the case of epigastric tenderness in the abdominal examination and if melena is present at the rectal examination, consider also COVID-19-associated gastrointestinal bleeding (53-year-old male from Adana, Turkey).


Zhai LL, Xiang F, Wang W, et al. Atypical presentations of coronavirus disease 2019 in a patient with acute obstructive suppurative cholangitis. Clin Res Hepatol Gastroenterol. 2020 May 21:S2210-7401(20)30141-8. PubMed: . Full-text:

Or an obstructive suppurative cholangitis (71-year-old woman with a one-week history of yellow skin, Wuhan, China).


Meireles PA, Bessa F, Gaspar P, et al. Acalculous Acute Pancreatitis in a COVID-19 Patient. Eur J Case Rep Intern Med. 2020 May 13;7(6):001710. PubMed: . Full-text: eCollection 2020

But, attention! If amylase and lipase levels increase to 6-700 U/l, it may be also be acalculous pancreatitis (36-year-old woman, Lisbon, Portugal).


Schepis T, Larghi A, Papa A, et al. SARS-CoV2 RNA detection in a pancreatic pseudocyst sample. Pancreatology. 2020 May 28:S1424-3903(20)30185-X. PubMed: . Full-text:

A pancreatic pseudocyst in which the virus can be detected and which can be successfully treated with endoscopic ultrasound-guided transgastric drainage using AXIOS™ Stent and Electrocautery Enhanced Delivery System (67-year-old woman, Rome, Italy).


Damiani GR, Biffi A, Del Boca G, Arezzo F. Abdominal pregnancy during the COVID-19 pandemic. Int J Gynaecol Obstet. 2020 Jun 10. PubMed: . Full-text:

Or, of course, in the case of a female patient of child-bearing age, an abdominal pregnancy has to be considered (33-year-old primigravida from Bari, Italy, presenting at 14 weeks of pregnancy with persistent abdominal pain lasting 15 days). But, please, be prepared when reading this report: worrying photos of the fetus located behind the posterior wall of the uterus, close to the rectosigmoid junction.


Rabice SR, Altshuler PC, Bovet C, Sullivan C, Gagnon AJ. COVID-19 infection presenting as pancreatitis in a pregnant woman: A case report. Case Rep Womens Health. 2020 Jul;27:e00228. PubMed: . Full-text:

Or consider both. Pregnancy AND pancreatitis (36-year-old woman, G4P2, at 33 weeks of gestation, from Denver, CO).


Kim J, Thomsen T, Sell N, Goldsmith AJ. Abdominal and testicular pain: An atypical presentation of COVID-19. Am J Emerg Med. 2020 Mar 31:S0735-6757(20)30194-7. PubMed: . Full-text:

But be careful: in male patients, it may be wiser to consider the testicles (42-year-old male with 8 days of abdominal, testicular, and back pain who had been, it’s worth mentioning, seated in the ED waiting room for 2 h prior to being roomed).


Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K. Traumatic non-missile penetrating transnasal anterior skull-base fracture and brain injury with cerebrospinal fluid leak: intraoperative leak detection and an effective reconstruction procedure for a localized skull base defect especially after COVID-19 outbreak. World Neurosurg. 2020 Jun 1:S1878-8750(20)31207-9. PubMed: . Full-text:

And please, finally, be also very careful these days while beekeeping, especially if you fall down on the ground near your bee hives (65-year-old male from Niigata, Japan). A garden pole may poke directly into your right nostril, leading to serous rhinorrhea. Not in all cases your CSF leakage will be caulked by endonasal endoscopic using an FFG plug which, according to the authors, is useful, “in particular for the post-COVID-19 era, because it is simple, low-cost, and timesaving: requiring no special skills or no sophisticated instruments, thus reducing infection risks during the surgery”. J