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Ampullitis Superimposed Obstructive Jaundice in a Patient With COVID-19 #MMPMID33737998
Cao C; Lakshminarayanan R; McCracken J; Lai J
Gastroenterology Res 2021[Feb]; 14 (1): 41-44 PMID33737998show ga
While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.
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Gastroenterology+Res 2021 ; 14 (1): 41-44
