Persistent hiccups as main COVID-19 manifestation with transient cytotoxic lesion of the corpus callosum splenium during the Omicron wave in the post-vaccination era

Sassi, Celeste; Mehmed, Emel; Alkhatib, Amir; Forero-Padilla, Mario Alberto; Goranov, Dragan S.; Habermann, Sylvia; Rekow, Sven; Grüger, Albert; Schmitt, Hans-Michael

doi:10.1007/s00415-022-11487-z

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…In some cases, COVID-19 associated cases have subsided in the absence of specific treatment [ 12 ]. In other cases, including my present case, hiccups responded to treatment with chlorpromazine [ 11 ]. In the case that was reported by Ali et al [ 14 ] the patient responded to treatment with Baclofen, a Gamma amino butyric acid (GABA) analogue which interrupts the hiccup reflex.…”

Section: Discussionsupporting

confidence: 55%

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Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report

Bwalya

2024

J Med Case Reports

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Introduction Hiccups are among the rare complications of COVID-19 infections. There are several published reports of persistent hiccups presenting during the acute COVID-19 period. However, there are very few published reports of persistent hiccups occurring in the post-acute COVID-19 period. Consequently, most clinicians may not be aware of this rare presentation. This case highlights an atypical presentation of persistent hiccups that manifested during the post-acute COVID -19 period that clinicians need to be aware of. The caseadds to the ever increasing body of knowledge about symptoms and signs associated with Severe Acute Respiratory Syndrome Corona Virus type 2 (SARS CoV-2) infection. Case presentation A 27 year old male black Zambian patient presented to the emergency department of our hospital with persistent hiccup, 35 days after the initial acute episode of COVID-19. This was associated with breathlessness. There were no other symptoms. He had no history of pulmonary, gastrointestinal, neurological disease or malignancy. He did not take any alcohol or smoke. He had never used any recreational drugs. He was employed as a monitoring and evaluation officer at one of the main COVID centres in the capital. On examination, the patient was anxious. Blood pressure was 141/82, pulse rate was 95 beats per minute, respiratory rate was 26 breaths per minute, temperature was 36.8C and oxygen saturation was 97% on room air. Systemic examination was normal. Chest X-ray and abdominal ultrasonography were normal. A rapid COVID-19 antigen test, and COVID-19 Polymerase Chain Reaction (PCR) test that were done the following day were negative. All other haematological and biochemical tests, including D-dimer and C-reactive protein (CRP), were also normal. A diagnosis of post-acute COVID-19 associated hiccups was made. The patient responded well to treatment with chlorpromazine 25 mg 8 hourly. The hiccups disappeared completely after the fourth dose of chlorpromazine. Conclusion This is one of the few published cases of COVID-19 associated persistent hiccups, occurring more than a month after the initial presentation. Most of the published cases report hiccups occurring in the acute COVID-19 period. Consequently, hiccups occurring in the post-acute COVID-19 period may not be attributable to COVID-19. This case has highlighted the need to consider post-acute COVID-19 in the differential diagnosis of persistent hiccup.

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Section: Discussionsupporting

confidence: 55%

“…Most of the cases of persistent hiccups described in COVID-19 presented early in the course of the infection [ 6 , 7 , 11 ]. In one systematic review, 14 out of 16 of the cases reviewed had hiccups before diagnosis of COVID-19 was confirmed [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report

Bwalya

2024

J Med Case Reports

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“… 12 We did not evaluate the variant of SARS‐CoV‐2 in this case, but the public survey for the SARS‐CoV‐2 variant in Japan showed that the predominant variant was the omicron sublineage BA.5 when our case was admitted to our hospital. It is true that the cases of MERS associated with other omicron sublineages have been reported, 9 , 13 but our case is the first report of MERS during the omicron sublineage BA.5 predominant era in Japan. Our case also shows that the alteration of the major variant does not affect the occurrence of MERS related to COVID‐19.…”

Section: Discussionmentioning

confidence: 64%

“…Our case also shows that the alteration of the major variant does not affect the occurrence of MERS related to COVID‐19. We found two cases who developed MERS related to COVID‐19 despite being vaccinated for SARS‐CoV‐2, 9 , 13 suggesting we will continue to encounter MERS related to COVID‐19.…”

Section: Discussionmentioning

confidence: 93%

A case of mild encephalitis associated with COVID‐19

Nagae,

Haraguchi,

Sakoh

et al. 2023

J of Gen and Family Med

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We report a case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a 31‐year‐old man. He had been diagnosed with mild COVID‐19 3 days earlier and presented to the emergency department with altered mental status. Brain magnetic resonance imaging (MRI) showed a high‐intensity area confined to the splenium of the corpus callosum on diffusion‐weighted imaging, which is consistent with MERS. MERS is characterized by a reversible change in the splenium of the corpus callosum. MERS secondary to COVID‐19 has been reported recently. It is important to consider MERS in COVID‐19 patients with impaired consciousness.

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Full moon mesencephalon sign: a transient cytotoxic lesion in a hemodialysis patient with newly diagnosed atrial fibrillation and severe stenosis of the right vertebral artery

Sassi,

Habermann,

Coria

et al. 2024

Neurol Sci

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Brain cytotoxic edema is a neuroradiological sign secondary to variegate diseases ranging from migraine to fulminant Listeria rhombencephalitis. The tempestive identification of its underlying cause is vital for an effective treatment as any delay may be fatal. However, the lack of distinctive imaging biomarkers and the paucity of reports pose a significant challenge in its diagnosis and frequently lead to a misdiagnosis particularly with the more common acute ischemic stroke. Importantly, due to its rarity, mesencephalon midline cytotoxic lesion is likely to remain an underdiagnosed clinical phenomenon, especially if follow up MRI is not performed. Here we report a case of a central, midline, symmetric midbrain cytotoxic edema in a haemodialysis patient with diverse chronic progressive severe cardiovascular risk factors and a newly diagnosed atrial fibrillation. We expand the spectrum of neuroradiological hallmarks associated to terminal renal failure and report a full moon-like mesencephalon midline transient restricted diffusion as a reliable imaging biomarker for the prompt and accurate diagnosis of midbrain cytotoxic edema with the enormous potential of rapidly identifying and effectively treating its causative factors and timely reverse the associated symptomatic.

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Persistent hiccups as main COVID-19 manifestation with transient cytotoxic lesion of the corpus callosum splenium during the Omicron wave in the post-vaccination era

Cited by 3 publications

References 15 publications

Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report

Persistent hiccups after acute COVID-19 successfully treated with chlorpromazine: a case report

A case of mild encephalitis associated with COVID‐19

Full moon mesencephalon sign: a transient cytotoxic lesion in a hemodialysis patient with newly diagnosed atrial fibrillation and severe stenosis of the right vertebral artery

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