Hiccups and psychosis: two atypical presentations of COVID-19

Abstract

The WHO defines a possible case of COVID-19 as a person experiencing fever, cough, shortness of breath, and neurological signs including anosmia, ageusia, or dysgeusia. However, experiences from hospitals all over the world have shown that presentations vary widely. Some atypical presentations include cardiac, gastrointestinal, neurological, and cutaneous and while some are driven by the inflammatory response, others are a consequence of the hypercoagulable state. In our emergency department in a private hospital in Mexico City, we received two patients with very different symptoms on the same shift. Two previously healthy men in their 40s presented to the ER with very atypical manifestations of COVID-19. Neither of them complained of fever, cough, or shortness of breath. The first referred a 3-day history of hiccups that had not resolved with metoclopramide. The second presented with an acute episode of altered mental status. While the first case revealed lung involvement of the disease, the second case had a clean chest CT scan. These cases are relevant as manifestations of COVID-19 vary widely, especially in previously healthy young adults.

COVID-19-associated psychosis: A systematic review of case reports

“…Finally, 18 articles did not include individual level data and 7 articles were available as abstracts only. A total of 40 articles met inclusion criteria, comprising 48 individual patients from 17 countries ( Table 1 ) [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. All but a single study [ 54 ] were in English and 20 (42%) cases were reported in the United States, where the largest proportion of these cases were documented.…”

“… Reported DX: acute psychosis or transient psychotic disorders DSM-5 Dx: Brief psychotic disorder Recent mechanical ventilation, treatment with dexamethasone and HCQ. Alvarez-Cisneros et al, 2021 [ 27 ] 43, M, MX Tachylalia, disorganized ideas, restlessness, delusions of grandeur, emotional lability, and aggression towards his mother presenting 3 days after father diagnosed with COVID-19. No symptoms A history of hetero-aggressive episodes which usually resolved over 48 h. None + SARS-CoV-2 PCR.…”

Hiccups as a specific neurological manifestation in males with COVID-19

“…We noticed that there were quite a few patients who developed hiccups. To date, 10 short cases have been reported on this topic [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . We witnessed five cases in succession; therefore, we assume that hiccups might be a specific symptom of COVID-19.…”

What is the frequency of singultus as unique symptom in patients with Covid-19?

“…SARS-CoV-2 has a neurogenic tropism recognized, the main mechanism known states that after binding to the receptors of the angiotensin converting enzyme II (ACE2) in the nasal epithelium, it invades the olfactory nerve and the bulb, progressing, to later invade the respiratory centers of the brainstem. To date, we have found in the literature six cases of persistent singultus in men positive to SARS-CoV-2 infection of different ethnic origin in the range of 48-62 years (table I), [1][2][3][4][5][6] three of them Mexican with comorbidity.…”

“…Armando Totomoch-Serra, PhD, MD, (1,2) totomoch@gmail.com Concepción B Ibarra-Miramon, MD, (3) Carlos Manterola, MD, PhD. (1,2) (…”