tetano
Editor, Senior Moderator
Gastroenterology Res
. 2021 Feb;14(1):41-44.
doi: 10.14740/gr1353. Epub 2021 Feb 19.
Ampullitis Superimposed Obstructive Jaundice in a Patient With COVID-19
Can Cao[SUP] 1 [/SUP], Renuka Lakshminarayanan[SUP] 2 [/SUP], John McCracken[SUP] 3 [/SUP], Jinping Lai[SUP] 2 [/SUP]
Affiliations
Abstract
While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.
Keywords: Ampullitis; Biliary brushing and cytopathology; Biliary intraepithelial neoplasia; COVID-19; Duodenitis; Endoscopic retrograde cholangiopancreatography; Hepatoencephalopathy.
. 2021 Feb;14(1):41-44.
doi: 10.14740/gr1353. Epub 2021 Feb 19.
Ampullitis Superimposed Obstructive Jaundice in a Patient With COVID-19
Can Cao[SUP] 1 [/SUP], Renuka Lakshminarayanan[SUP] 2 [/SUP], John McCracken[SUP] 3 [/SUP], Jinping Lai[SUP] 2 [/SUP]
Affiliations
- PMID: 33737998
- PMCID: PMC7935611
- DOI: 10.14740/gr1353
Abstract
While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.
Keywords: Ampullitis; Biliary brushing and cytopathology; Biliary intraepithelial neoplasia; COVID-19; Duodenitis; Endoscopic retrograde cholangiopancreatography; Hepatoencephalopathy.