COVID-19 Infection in a Child Presenting With Functional Intestinal Obstruction

This report describes the case of a 13-year-old male patient presenting with functional small bowel obstruction. The child was also observed to have persistent tachycardia, and repeat cardiac examination revealed a new-onset cardiac murmur and a gallop rhythm. Acute viral myocarditis was clinically suspected, prompting further cardiac evaluations including electrocardiogram (EKG), echocardiogram (echo), and cardiac enzyme panel. Both EKG and echo findings suggested acute myocardial injury, in addition to elevated levels of cardiac enzymes and other inflammatory markers. Considering the ongoing pandemic, coronavirus disease 2019 (COVID-19) infection was suspected, but reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Because multisystem inflammatory syndrome in children (MIS-C) may occur later in the course of COVID-19 illness, a SARS-CoV-2 antibody test was performed, with positive results. To our knowledge, this is the first pediatric case of COVID-19 presenting as functional intestinal obstruction. We present this case to share our findings on this unique manifestation of COVID-19 with pediatric colleagues. We also engage in a brief review of MIS-C.