Persistent hiccups as an atypical presenting complaint of COVID-19

Abstract

Hiccups (singultus) are reflex inspiratory movements that involve the swallowing reflex arc and can be classified as acute (<48 h) or persistent (>48 h). A 62-year-old man with no history of malignancy or pulmonary disease presented to the Emergency Department with a four-day history of persistent hiccups. Other than episodic hiccupping, his physical examination was otherwise unremarkable. An abnormal chest X-ray led to a CT scan of the chest with IV contrast, which demonstrated regional, peripheral groundglass opacities of the upper lobes with small focal groundglass opacities scattered throughout the lungs. He was tested for COVID-19 per admission protocol, started on hydroxychloroquine, his hiccups improved, and he was discharged to home after 3 days. An emergency medicine physician should keep COVID-19 on the differential and be vigilant of exposure in atypical presentations.

Fig. 1

A chest radiograph demonstrating groundglass opacities in the right upper lung, left mid and lower lungs, and right costophrenic angle.

Fig. 2

A computed tomography scan of the chest demonstrating peripheral groundglass opacities of the upper lung lobes.

Fig. 3

A computed tomography scan of the chest demonstrating scattered ground glass opacities in the lower lung lobes.