Summary
The initial clinical presentation of coronavirus disease 2019 may be appendicular syndrome. An abdominal CT scan ruled out a diagnosis of appendicitis and a chest CT scan yielded a diagnosis of SARS-CoV-2 infection. CT scan is required before considering emergency surgery for acute appendicitis.
Keywords: Appendicitis, TDM, Coronavirus Disease 2019, COVID-19
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can appear in different forms of clinical presentation [1]. During this pandemic period, it is important to consider it as a possible diagnosis, even in the event of an abdominal pain syndrome suggesting acute appendicitis. Screening for a co-infection prior to emergency surgery can modify the patient circuit and lead to reassessment of the therapeutic proposal. In some cases, it may even yield a differential diagnosis necessitating not surgery, but pronouncedly different medical treatment.
A 63-year-old female patient having had an ischemic stroke and with AHT history, non-insulin-dependent diabetes and a BMI of 45, presented in an emergency department for abdominal pain during a period of SARS-CoV-2 pandemic. The pain evolved for 4 days, occasionally associated with diarrheal stools. A single vomiting episode was reported. Prior to arrival in emergency, her temperature at home was 38.1°.
Rendered difficult due to plethoric abdomen, clinical examination localized the febrile abdominal pain in the right iliac fossa. No extra-digestive manifestations or signs of respiratory distress syndrome was reported. The hemodynamic constants were normal, as was the patient's temperature on admission to emergency. Biological analysis objectified a moderate inflammatory syndrome with CRP at 89 and 5900 GB (absence of leucopenia and lymphopenia).
CT-scan was called for in order to diagnose acute appendicitis in accordance with current recommendations [2]. As the patient's appendix appeared normal, the examination highlighted the inaccuracy of the original, provisional diagnosis (Fig. 1 ). The radiology team then decided to obtain images of the thorax and changed the diagnosis to one of COVID-19 (Fig. 2 ) [3]. The patient was not operated.
Figure 1.
Abdominopelvic CT-scan. Normal appendix (arrow).
Figure 2.
Thoracic CT-scan objectifying ground glass opacities, highly suggestive of COVID-19 with moderate parenchymal injury.
Disclosure of interest
The authors declare that they have no competing interest.
Références
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