Severe COVID-19 initially presenting as mesenteric adenopathy
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CASE REPORT
Severe COVID-19 initially presenting as mesenteric adenopathy Sakura Noda 1,2
&
Jimmy Ma 3 & Erin K. Romberg 1,2 & Rafael E. Hernandez 4,5 & Mark R. Ferguson 1,2
Received: 20 May 2020 / Revised: 1 July 2020 / Accepted: 27 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Coronavirus disease 2019 (COVID-19) can present with abdominal pain in children and adults. Most imaging findings have been limited to characteristic lung findings, as well as one report of bowel-ischemia-related findings in adults. We report a case of COVID-19 in a healthy teenager who initially presented with isolated mesenteric adenopathy, typically a self-limited illness, which progressed to severe illness requiring intensive care before complete recovery. The boy tested negative for COVID-19 twice by polymerase chain reaction (PCR) from upper respiratory swabs before sputum PCR resulted positive. A high index of suspicion should be maintained for COVID-19 given the continued emergence of new manifestations of the disease. Keywords Abdomen . Adolescent . Computed tomography . Coronavirus . COVID-19 . Lymph nodes . Mesentery . Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Introduction Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), the causative agent of coronavirus disease 2019 (COVID-19), caused almost 13 million confirmed infections globally as of July 14, 2020 [1]. While most infected individuals are asymptomatic or experience only self-limited respiratory illness, others develop severe multisystemic illness resulting in more than 570,000 deaths worldwide [1]. Because of its highly contagious and potentially lethal nature, identifying the varied presentations of COVID-19 is important for prompt and accurate diagnosis. We describe a pediatric patient who presented with abdominal pain and was diagnosed with mesenteric adenopathy — * Sakura Noda [email protected] 1
Department of Radiology, Seattle Children’s Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA 98104-5005, USA
2
Department of Radiology, University of Washington, Seattle, WA, USA
3
Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
4
Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, WA, USA
5
Department of Pediatrics, University of Washington, Seattle, WA, USA
typically a self-limited illness — but who was ultimately diagnosed with COVID-19. Notably, no initial clinical symptoms or CT findings suggested COVID-19 respiratory infection. Gastrointestinal symptoms including diarrhea, vomiting and abdominal pain are known manifestations of COVID19. Reported imaging findings in patients with gastrointestinal symptoms have mostly been limited to lung-base abnormalities [2]. One recent study of adults with COVID-19 identified abdominal imaging findings of bowel wall thickening, pneumatosis, and portal venous gas suggestive of ischemia secondary to small-vessel thrombosis, some confirmed by pathology [3]. Isolated mesenter
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