Ampullitis Superimposed Obstructive Jaundice in a Patient With COVID-19

Area of Science:

• Infectious Diseases
• Hepatology
• Gastroenterology

Background:

• Coronavirus disease 2019 (COVID-19) typically manifests with respiratory symptoms.
• However, extrapulmonary manifestations and multi-systemic involvement are increasingly recognized.
• Atypical presentations necessitate a broader diagnostic approach.

Observation:

• An 83-year-old male with a history of abdominal aortic aneurysm repair and colostomy presented with altered mental status, fever, and jaundice.
• Initial workup revealed duodenitis, ampullitis, and suspected Klatskin tumor, leading to biliary obstruction, sepsis, and hepatoencephalopathy.
• The patient tested positive for COVID-19 but had no initial respiratory symptoms or abnormal chest X-ray findings.

Findings:

• The patient's presentation was characterized by severe gastrointestinal and hepatobiliary complications secondary to COVID-19.
• Hepatoencephalopathy developed in the absence of significant pulmonary involvement.
• Hypoxia occurred late in the disease course, underscoring the variability of COVID-19 progression.

Implications:

• This case underscores the importance of considering COVID-19 in patients with atypical, extrapulmonary symptoms, particularly gastrointestinal and hepatobiliary presentations.
• Early recognition and investigation of non-respiratory COVID-19 manifestations are crucial for timely management.
• The findings emphasize the need to broaden diagnostic considerations for COVID-19 beyond typical respiratory indicators.