Appendicitis as a presentation of COVID-19: A case report

Abstract

Background Coronavirus disease-19 (COVID-19) is an infectious respiratory disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Respiratory symptoms and flu-like presentation are the most defined clinical manifestations. However, gastrointestinal symptoms with acute abdomen have been reported in a small percentage, occasionally mimicking acute appendicitis. Hence, the diagnosis of COVID-19 should be suspected and investigated in every case of acute abdomen in the present situation. Case presentation We report a case of a 25-year-old male who presented with features of acute appendicitis. Despite the equivocal ultrasound results, he was scheduled for an emergency appendectomy for Alvarado's score 7 out of 10, who underwent a successful appendectomy. The patient had initially tested negative on an upper respiratory COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) with normal chest X-ray but few hours after the surgery patient developed a high-grade fever. An RT-PCR for COVID-19 was resent following a suspicion that came out to be positive. Clinical discussion Several case reports have suggested a probable association between COVID-19 and appendicitis. This case shows the limited effectiveness of clinical diagnosis for the surgical abdomen in COVID-19 patients as these two conditions share similar symptoms often needing a clinical vigilance. Conclusion This case reports acute appendicitis in a patient who tested positive for SARS-CoV-2 subsequently following emergency appendectomy highlighting the acute gastrointestinal presentation of COVID-19. This case exemplifies the necessity to be familiar with the gastrointestinal symptoms of COVID-19 and maintain a high level of suspicion for COVID-19 infection in cases of abdominal pain.

COVID‑19‑associated acute appendicitis in adults. A report of five cases and a review of the literature

“…As regards respiratory systems, some patients did not present with any respiratory symptoms, whereas others had more severe symptoms and suffered from COVID-19-related pneumonia. The diagnosis of acute appendicitis may precede the diagnosis of SARS-CoV-2 infection, may follow the diagnosis of SARS-CoV-2 infection or may be simultaneous to the diagnosis of SARS-CoV-2 infection ( 6 , 10-17 ). COVID-19-associated acute appendicitis has also been reported during pregnancy ( 17 ).…”

“…In rare situations, it may even lead to a differential diagnosis that requires a markedly different medical therapy rather than surgery ( 5 ). However, there have been reports of a few cases of acute appendicitis associated with SARS-CoV-2 infection ( 6 ). Due to the high infectivity and potential for extensive lung damage, healthcare professionals have to react quickly to treat individuals who have been diagnosed with COVID-19, while they are concurrently suffering from other diseases, such as acute appendicitis ( 7 ).…”

Impact of the COVID-19 Pandemic on the Pediatric Hospital Visits: Evidence from the State of Florida

“…This increase in hospital visits may be caused by the delayed/deferred care in patients during the early months of pandemic and, therefore, increased the inpatient care visits with more complicated conditions [ 11 ]. This finding could also be associated with the cases of post-COVID-19 health complications and an increase of the adenovirus associated with acute appendicitis [ 35 , 36 ]. Several case reports have suggested a probable association between COVID-19 and subsequent acute appendicitis [ 36 ].…”

“…This finding could also be associated with the cases of post-COVID-19 health complications and an increase of the adenovirus associated with acute appendicitis [ 35 , 36 ]. Several case reports have suggested a probable association between COVID-19 and subsequent acute appendicitis [ 36 ]. Perhaps the most alarming findings of our study are a substantial steady decline in visits with sickle cell disorder, which is more prevalent in African American children insured with Medicaid and are rarely treated outside of hospital settings [ 37 , 38 ].…”

COVID-19 and the Gastrointestinal Tract

“…The incidence of surgical abdomen in COVID-19 patients remains to be described. SARS-CoV2-nduced mucosal injury, hyper-immunity and over-inflammation leading to hypercoagulability and regional ischemia of the gut may lead to different surgical-like clinical presentations, including diffuse acute abdominal pain, enteritis, pseudoappendicitis, appendicitis, and acute mesenteric ischemia [60][61][62][63][64]. Even when COVID-19 has been reported to be associated with intussuception and mesenteric lymphoid hyperplasia (most commonly in children), it has also been reported in adults and must be taken into account in adult patients [65][66][67].…”