Abstract

Introduction: The aim of this case report is to highlight that COVID-19 can have several presentations including a clinical picture of appendicitis, thus thorough physical examination and investigations are warranted to properly identify the underlying cause even if it is a rare one. Since the emergence of the COVID-19 outbreak in Wuhan, China, the World Health Organization (WHO) declared the COVID-19 a pandemic which is continuing to spread across the globe. The most common clinical presentation of a patient with COVID-19 is respiratory symptoms manifested primarily by dry cough and fever. To date, the full picture of a patient with COVID-19 is still not clear and it can be mistaken with other unusual presentations. The highest mortality rates worldwide were seen among the adult and elderly populations. Moreover, involvement of the gastrointestinal system has been reported as well.

Case Report: We describe a case of a 13 years old male patient known to have behçet disease maintained on colchicine, presented to the emergency department for periumbilical abdominal pain radiating to the right lower quadrant with nausea, anorexia of 1-day duration, and myalgia of 2 days duration. This presentation was not associated with vomiting, fever, and diarrhea. This patients’ symptoms were suggestive of appendicitis to which he underwent appendectomy, which appeared to be normal after pathological analysis, but turned out to be COVID-19 positive despite doing the polymerase chain reaction (PCR) and rapid antigen test upon admission which were negative. This patient didn’t portray any symptoms suggestive of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Conclusion: A positive clinical examination of appendicitis is an important finding and should be further investigated by imaging and lab tests as it could be mistaken by a COVID-19 infection.

Keywords: COVID-19; Acute Appendicitis; Respiratory Symptoms; Gastrointestinal Symptoms

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