Stowaway in the endoscopic unit: be careful with isolated GI-symptoms in the Covid-19 era

A 61 yr old woman was admitted to the emergency department due to nausea and weakness for 1 week without any improvement on proton pump inhibitors. She denied any vomiting, pain, stool abnormality, cough, fever or dysuria; she was negative on the Covid-19 risk stratification for respiratory/infectious symptoms, contact persons and physical examination [1].

Laboratory tests showed 3600 leukocytes/µl and discrete lymphopenia, and CRP

(1.2 mg/dl, norm  <  0.5).

She underwent EGD without facial mask; only a minor antral gastritis was found. US of the abdomen showed large biliary stones without signs for cholecystitis or cholestasis, but an ecstatic right kidney. Therefore, a CT of the abdomen was ordered to rule out a ureteral pathology. Surprisingly, cranial CT section were suggestive of bilateral ground glass opacities in the lower parts of the lung (figure 1). The conventional chest x-ray showed bilateral infiltrates (figure 2). The subsequent Sars-CoV2-RT-PCR was positive, and the patient put on quarantine, as well as all interacting staff personnel.

This highlights the danger of asymptomatic/atypical presentation of the Covid-19 infection which may results in 5-25% of all infected persons. Thus, isolated symptoms, e.g. olfactory signs, GI- symptoms, acute myocardial infarction and ocular symptoms should rise suspicion of Covid-19 leading to pre-endoscopic testing and/or use of appropriate protective masks (figure 3) [1-5].

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Artikel online veröffentlicht:
08. September 2020