COVID-19 presenting as persistent hiccups: a case report

Sene, Diogo Ribeiro de; Watashi, Diego Moreno; Bilitardo, Isabella de Oliveira; Moreno, Carlos Eduardo Campos; Moreno, Mariella Freire de Freitas

doi:10.1590/S1678-9946202163062

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Case Report • Rev. Inst. Med. trop. S. Paulo 63 • 2021 • https://doi.org/10.1590/S1678-9946202163062 copy

COVID-19 presenting as persistent hiccups: a case report

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Hiccups are involuntary, spasmodic contractions of the diaphragm and intercostal muscles and can be classified as acute (< 48 h), persistent (48 h to a month) or intractable (> 1 month). A previously healthy 29-year-old man sought the Emergency Department with flu-like symptoms and a two-day history of persistent hiccups. His physical examination was otherwise unremarkable and vital signs were within normal limits. An unenhanced computed tomography scan of the chest showed small focal ground-glass opacities scattered throughout 25% of the lungs. A COVID-19 test was positive. Chlorpromazine was prescribed for the hiccups with improvement over 10 h. The patient was discharged home on the same day without hiccups and no other complications.

KEYWORDS
COVID-19; Hiccups; SARS-CoV-2; Chlorpromazine; Atypical presentation

	Gender and age of the patient (years)	Presentation	Laboratory tests and imaging	Treatment	Outcome
Our case	Male 29	Persistent hiccups Two-day history	Chest CT scan with ground-glass opacities and small sparse areas of atelectasis Positive RT-PCR for SARS-CoV-2	Chlorpromazine	Symptoms improved after 10 h
Dorgalaleh et al.⁹9. Dorgalaleh A, Dabbagh A, Tabibian S, Bahraini M, Rafieemehr H. Persistent hiccups in a patient with mild congenital factor V deficiency and COVID-19; clinical and laboratory finding of a rare bleeding disorder. Int J Lab Hematol. 2021;43:e87-8.	Male 52	Persistent hiccups	Chest CT scan with ground-glass in the left lower lobe Positive RT-PCR for SARS-CoV-2	Metoclopramide Chlorpromazine	Symptoms improved after 5 days
Ikitimur et al.¹⁰10. Ikitimur H, Borku Uysal B, Ikitimur B, Umihanic S, Smajic J, Jahic R, et al. Two cases of persistent hiccups complicating COVID-19. Am J Trop Med Hyg. 2021;104:1713-5.	Male 60	Persistent hiccups Three-day history	Chest CT scan with ground-glass in the left lower lobe Positive RT-PCR for SARS-CoV-2	Chlorpromazine	Symptoms improved after 12 h
	Male 68	Persistent hiccups	Chest CT scan with ground-glass in the left lower lobe Positive RT-PCR for SARS-CoV-2	Chlorpromazine	Symptoms improved after 3 days
Prince and Serge⁵5. Prince G, Sergel M. Persistent hiccups as an atypical presenting complaint of COVID-19. Am J Emerg Med. 2020;38:1546.e5-6.	Male 62	Persistent hiccups Four-day history	Chest CT scan with ground-glass opacities Positive RT-PCR for SARS-CoV-2	None	Symptoms improved
Bakheet et al.¹¹11. Bakheet N, Fouad R, Kassem AM, Hussin W, El-Shazly M. Persistent hiccup: a rare presentation of COVID-19. Respir Investig. 2021;59:263-5.	Male 48	Persistent hiccups Seven-day history	Chest CT scan with ground-glass opacities Positive RT-PCR for SARS-CoV-2	Baclofen	Symptoms improved
Alvarez-Cisneros et al.¹²12. Alvarez-Cisneros T, Lara-Reyes A, Sansón-Tinoco S. Hiccups and psychosis: two atypical presentations of COVID-19. Int J Emerg Med. 2021;14:8.	Male 48	Persistent hiccups Four-day history	Chest CT scan with ground-glass opacities Positive RT-PCR for SARS-CoV-2	Metoclopramide, omeprazol, ondanseteon and oral frappe megaldrate/ dimeticone	No improvement Patient refused hospital admission and was lost to follow-up
Totomoch-Serra et al.¹³13. Totomoch-Serra A, Ibarra-Miramon CB, Manterola C. Persistent hiccups as main COVID-19 symptom. Am J Med Sci. 2021;361:799-800.	Male 60	Persistent hiccups	Chest X-ray showing lung parenchyma with decreased radiolucency of images with poorly defined irregular edges	Clonazepam Haloperidol	Symptoms improved after 3 days
Sangamesh et al.¹⁴14. Sangamesh S, Gosavi S, Shastry S, Johny SM. Hiccups and hyponatremia: unusual co-presentation in COVID-19. J Family Med Prim Care. 2021;10:1040-3.	Male 72	Persistent hiccups Five-day history	Chest X-ray with bilateral lower lobe infiltrates Positive RT-PCR for SARS-CoV-2	Baclofen	Symptoms improved after 2 days
Atiyat et al.¹⁵15. Atiyat R, Veeraballi S, Al-Atiyat N, Chan KH, Slim J. A rare case report of persistent hiccups as an atypical presentation of COVID-19. Cureus. 2021;13:e13625.	Male 61	Persistent hiccups Two-day history	Chest X-ray with bilateral middle lung opacities Positive RT-PCR for SARS-CoV-2	Metoclopramide	-
Chiquete et al.¹⁶16. Chiquete E, Toapanta-Yanchapaxi L, Aceves-Buendía JJ, Ruiz-Ruiz E, Rodríguez-Perea E, Durán-Coyote S, et al. Levosulpiride relieved persistent hiccups in a patient With COVID-19 and vascular cognitive impairment. Clin Neuropharmacol. 2021 In Press.	Male 62	Persistent hiccups Five-day history	Chest CT scan with viral pneumonia Positive RT-PCR for SARS-CoV-2	Levomepromazine Levosulpiride	Symptoms improved after 3 days

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[1] Correspondence to: Diego Moreno Watashi, Universidade de Mogi das Cruzes, Av. Dr. Cândido Xavier de Almeida e Souza, 200, CEP 08780-911, Mogi das Cruzes, SP, Brazil. Tel: +55 11 98414-3888 E-mail: diegowatashi@hotmail.com