One disease, many faces-typical and atypical presentations of SARS-CoV-2 infection-related COVID-19 disease

Abstract

Since the appearance of the novel coronavirus (severe acute respiratory syndrome-coronavirus-2) and related coronavirus disease 2019 (COVID-19) in China in December 2019, a very high number of small and large patient series have been published in literature from around the world. Even though the classical presentation of COVID-19 is one with respiratory symptoms with or without pneumonia that can be self-limiting or evolve into severe respiratory distress syndrome with multiple organ failure, and secondary bacterial sepsis, a large body of evidence suggests a plethora of other types of clinical presentation. In this exhaustive review, we reviewed all of the published literature on COVID-19 to identify different types of clinical presentations affecting various organ systems, to provide an in-depth analysis that may prove useful for clinicians and health-workers on the frontline, battling the severe pandemic.

Keywords: Adult respiratory distress syndrome; Sepsis; COVID-19; SARS-CoV-2; World Health Organization; Centers for disease control

Core Tip: The novel severe acute respiratory syndrome-coronavirus-2 virus causing coronavirus disease 2019 (COVID-19) pandemic can present with typical or atypical symptoms and signs. Classical clinical presentation includes fever, cough, and sore throat with or without other associated symptoms such as anorexia, nausea, and lethargy in the presence or absence of pneumonia, which is commonly noted as ground-glass opacities on chest imaging. Gastrointestinal and hepatic involvement is very non-specific, but diarrhoea is known to predominate in some patients in the absence of typical symptoms and signs. Other systems involvement include electrographic abnormalities associated with clinical events such as syncope, viral myocarditis-related cardiac failure, meningoencephalitis, and acute inflammatory demyelinating polyneuropathy, a dermatological presentation with diffuse urticaria or viral exanthem, smell and taste dysfunction and local and systemic venous thromboembolism. Other rare presentations include keratoconjunctivitis and otitis media. Physicians caring for, and battling on the frontlines against COVID-19 should be aware of the “many faces” that this singular disease can present with, for timely diagnosis and prompt initiation of best treatment options.