Coronavirus Disease 2019 Presenting as Abdominal Distension in a Mesothelioma Patient: Do We Need to Think Outside the Box?

Our plain-English summary of Coronavirus Disease 2019 Presenting as Abdominal Distension in a Mesothelioma Patient: Do We Need to Think Outside the Box?, by M. Irfan, T. Almas, I. Ullah, et al (Curēus, 2020).

The study

• Authors: M. Irfan, T. Almas, I. Ullah, E. Tran, A. Ali
• Journal: Curēus
• Published: 2020;12(8):e9947
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

The coronavirus disease 2019 (COVID-19) remains a major source of mortality globally. Although it usually presents with flu-like symptoms such as fever and sore throat, the intensity of the symptoms varies, constituting a spectrum ranging from asymptomatic to severe cases of acute respiratory failure. The highest proportion of severe cases occurs in older individuals and in those who have underlying health conditions and chronic comorbidities. We chronicle an atypical case of a 46-year-old male with stage IV mesothelioma who presented exclusively with complaints of acute abdominal pain and distension. Despite his cancer status, the patient's respiratory functions remained unremarkable, accentuating the peculiarity of the case.

Copyright © 2020, Irfan et al.

In plain English

This article was a case report about one patient. A 46-year-old man with stage IV mesothelioma and hepatitis C, who had been on chemotherapy for 15 months, came to an emergency department with sudden abdominal pain and swelling. His abdomen was distended and tense from fluid (ascites). His chest was clear on examination, his heart rate was 112 beats per minute, and his oxygen saturation was 90% without oxygen support, below the normal range of 95-100% given in the article. A COVID-19 PCR test, done because of his mesothelioma, was positive. A chest CT scan showed ground-glass opacities and a large mass filling the left side of the chest, with pleural thickening that matched his earlier mesothelioma diagnosis. Draining the abdominal fluid (paracentesis) quickly relieved his symptoms. According to the authors, he showed no symptoms of COVID-19-related breathing problems and remained well without needing ventilation or oxygen. The article did not mention asbestos exposure. The authors concluded that physicians should remain aware of the possibility of gastrointestinal symptoms resulting from COVID-19 infection, even when respiratory symptoms are absent.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 46-year-old man with stage IV mesothelioma and hepatitis C, on chemotherapy for the previous 15 months, seen in an emergency department. The article does not state where or when he was treated.
• Exposure: COVID-19 (SARS-CoV-2) infection, confirmed by PCR, in a patient with stage IV mesothelioma. No asbestos or fiber exposure is described.
• Main results:
  • The patient came in with acute abdominal pain and distension. His abdomen was distended and tense due to ascites.
  • On arrival his oxygen saturation was 90% without oxygen support (normal range given as 95-100%), and his chest was clear on both sides.
  • On arrival his heart rate was 112 beats per minute (normal range given as 60-100).
  • His COVID-19 PCR test was positive.
  • The chest CT showed ground-glass opacities.
  • The chest CT also showed a large lobulated mass filling the left hemithorax, with lymph node enlargement and pleural thickening, consistent with his prior diagnosis of stage IV mesothelioma.
  • The patient showed no symptoms suggestive of COVID-19-induced respiratory compromise.
  • Paracentesis (draining the abdominal fluid) promptly relieved his symptoms.
  • At the time of reporting, the patient remained well without needing ventilation or oxygen.
• The authors' conclusion: The authors concluded that presentation of COVID-19 with gastrointestinal symptoms is rare, and that physicians should remain aware of the possibility of gastrointestinal symptoms resulting from COVID-19 infection even without respiratory symptoms.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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