key: cord-1036401-cong42hq
authors: Totomoch-Serra, Armando; Ibarra-Miramon, Concepcion B.; Manterola, Carlos
title: Persistent hiccups as main COVID-19 symptom
date: 2021-01-08
journal: Am J Med Sci
DOI: 10.1016/j.amjms.2021.01.001
sha: 0fe0a1465cdbad9151d1d968d9a214aeca43821f
doc_id: 1036401
cord_uid: cong42hq

nan

Armando Totomoch-Serra, PhD 1,* , Concepcion B. Ibarra-Miramon, MD 2 , Carlos Manterola, PhD 1,3 1 PhD Program in Medical Sciences, Universidad de La Frontera (UFRO), Temuco, Chile. 2 

There is no conflict of interest.

In this letter, we would like to share our experience in the diagnosis of a clinical case of COVID-19, in a 60-year-old Mexican male with persistent singultus and no previous history of any respiratory disease. Nonetheless, the patient reported a history of a sedentary lifestyle, obesity and an umbilical hernioplasty 7 years ago.

At the onset of the disease the patient manifested symptoms similar to those of a common cold, with fever, and persistent singultus (> 48 hours), he consequently sought medical care and was examined by a general physician who indicated acetaminophen, metoclopramide, and ilaprazole to control the symptoms. Several days after the consultation, the patient developed dysgeusia. In light of the above and the lack of control of the symptoms, hematic biometry and blood chemistry of 27 elements, measurement of D-dimer levels and posterior chest X-ray were ordered for the patient.

The following parameters from these studies were abnormal: Gamma glutamyl transpeptidase 70U/L, cholesterol 56 U/L, high-density cholesterol 27.1 mg/dL, pyruvic glutamic transaminase 56 U/L, lactic dehydrogenase 453 U/L, serum sodium 132 mmol/L, serum iron 35 ug/dL, serum calcium 7.9 mg/dL and dimer D 1.16 pg/mL. Chest X-ray showed lung parenchyma with decreased radiolucency of images with poorly defined irregular edges, in relation to probable peribronchial thickening, in the oximetry SpO2 reading, oxygen saturation of 87% was noted.

Given these results, hospital admission was recommended, the patient however ultimately refused hospitalization. A nasal and pharyngeal sample was taken by means of a hyssop for molecular study and identification of the SARS-CoV-2. Oral treatment of 2% lidocaine was indicated for treatment of the main symptom, nevertheless symptoms persisted after two days. Alternatively, clonazepam and haloperidol were indicated, remission of singultus was reported at 72 hours and symptoms eventually disappeared at 96 hours. The real-time PCR-result was positive for the identification of Gene N, Gene E, and Gene RdRp, and positive for SARS-CoV-2. To date, the patient remains asymptomatic, with no apparent sequelae from the disease.

At the end of February 2020, the first case of SARS-CoV-2 was reported in Mexico, with Mexico City and its metropolitan area reporting the highest incidence and with a mortality rate reported rates greater than 10% nationwide. However, the number of unidentified and asymptomatic cases is high, which could raise the current numbers of reported cases. 1 In the context of symptoms manifested during the infection, with the increase in the number of series and case reports, as well as the results of various epidemiological studies, a greater number of symptoms related to the disease have been identified.

Neurotropism for SARS-CoV-2 has been proposed in recent studies, with a variety of associated neurological symptoms. 2 As far as singultus is concerned, nerve involvement in the infection are phrenic and vagus, as well as the sympathetic nervous system and the brain areas related to the development of the singultus. 3 

An Italian Multicenter Retrospective-Prospective Observational Study on Neurological Manifestations of COVID-19 (NEUROCOVID) Neurol Sci

Persistent hiccups as an atypical presenting complaint of COVID-19

Membrane cholesterol modulates oligomeric status and peptide-membrane interaction of severe acute respiratory syndrome coronavirus fusion peptide

Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review

To the patient's family and the health care personal who assisted in part of the diagnosis, ATS would like to thank CONACYT