Inaccurate nasopharyngeal testing in a patient with gastrointestinal COVID19: A case report

Ramaraj, Akila B.; Rice-Townsend, Samuel E.

BACKGROUND: The accuracy of routine nasopharyngeal (NP) COVID19 testing in patients without respiratory symptoms is unknown. We describe a patient who presented with only gastrointestinal symptoms who tested negative twice, highlighting a variation of this disease that may be more difficult to defect by standard testing. CASE: A 17-year-old boy presented with 5 days of abdominal pain, headaches, vomiting and fevers. He was initially evaluate at another hospital where an NP swab was negative for COVID19. On presentation to our facility he had clinical signs of sepsis. Small bowel edema and ground glass consolidations were seen in both lung bases on CT. A second COVID19 NP test was negative. Sputum PCR testing was performed and ultimately returned positive. The patient eventually recovered and was discharged home. DISCUSSION: A high index of suspicion for COVID19 must be maintained in the face of diagnostic uncertainty given the variable presentation of this disease. sIn patients who present with GI-predominant symptoms, accuracy of standard testing may be lower.