COVID-19 presenting with persistent hiccup and myocardial infarction in a peritoneal dialysis patient: A case report

doi:10.5501/wjv.v11.i4.198

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Case Report

World J Virol. Jul 25, 2022; 11(4): 198-203
Published online Jul 25, 2022. doi: 10.5501/wjv.v11.i4.198

COVID-19 presenting with persistent hiccup and myocardial infarction in a peritoneal dialysis patient: A case report

Dimitra Bacharaki, Panagiotis Giannakopoulos, Konstantinos Markakis, Christos Papas, Aikaterini Theodorou, Vasiliki Zoi, Georgios Tsivgoulis, Sophia Lionaki

Dimitra Bacharaki, Panagiotis Giannakopoulos, Vasiliki Zoi, Sophia Lionaki, Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece

Konstantinos Markakis, Department of Internal Medicine, Attikon University Hospital, Chaidari 12462, Greece

Christos Papas, Department of Cardiology, Attikon University Hospital, Chaidari 12462, Greece

Aikaterini Theodorou, Georgios Tsivgoulis, Second Department of Neurology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

Author contributions: Bacharaki D was the attending consultant nephrologist and wrote the article; Giannakopoulos P was the resident nephrologist; Markakis K was the attending physician of the Infectious Department; Papas C was the attending cardiologist; Theodorou A as Resident of Neurology and Tsivgoulis G as Professor of Neurology were the neurologists consulted for hiccup; Zoi V was the peritoneal dialysis nurse; Lionaki S supervised the manuscript and was responsible for the language editing; all authors have read and approved the final manuscript.

Informed consent statement: The study participant provided informed written consent for the case report.

Conflict-of-interest statement: The authors have nothing to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Dimitra Bacharaki, MD, PhD, Consultant Physician-Scientist, Department of Nephrology, Attikon University Hospital, Rimini 1, Chaidari 12462, Greece. bacharaki@gmail.com

Received: December 24, 2021
Peer-review started: December 24, 2021
First decision: March 16, 2022
Revised: May 1, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: July 25, 2022
Processing time: 209 Days and 22.4 Hours

Abstract

BACKGROUND

Persistent hiccups, lasting more than 48 h, have been described as an atypical presentation of coronavirus disease 19 (COVID-19) in the general population. To the best of our knowledge, this is the first report of persistent hiccups and non-ST elevation myocardial injury (NSTEMI) as an atypical presentation of COVID-19 in a peritoneal dialysis (PD) patient.

CASE SUMMARY

A 70-year old man, who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction, presented for a scheduled radionuclide myocardial scan. Upon arrival, he complained of anorexia, nausea for 5 d, and unremitting hiccups for the previous 48 h. Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2. COVID-19 lung involvement was mild and was resolved without specific treatment. Myocardial injury was managed by coronary catheterization and stenting, while hiccups responded only to baclofen per os.

CONCLUSION

Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients, which may be due to involvement of the central nervous system and myocardial injuries.

Keywords: COVID-19; Peritoneal dialysis; Atypical presentation; Hiccup; Myocardial infarction; Baclofen; Case report

Core Tip: A 70-year old man with end-stage kidney disease on peritoneal dialysis, presented for a scheduled myocardial scan due to ischemic heart failure. Upon arrival, he complained of persistent hiccups during the last 2 d along with anorexia and vomiting for the last 5 d. He was diagnosed with coronavirus disease 2019 (COVID-19) and non-ST elevation myocardial infarction (NSTEMI). Hiccups and NSTEMI are postulated to represent atypical COVID-19 manifestations involving the nervous system and the heart.