Unusual Presentation of COVID Pneumonia as Esophageal Rupture Ended With Successful Management

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a severe respiratory syndrome. It started as an epidemic in Wuhan, China, and then become a global pandemic. COVID-19 usually presents with respiratory symptoms, including cough and shortness of breath, accompanied by fever. However, gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain, have also been reported as a less common presentation of COVID-19. Boerhaave syndrome is a transmural perforation of the esophagus that typically occurs after forceful emesis, which should be differentiated from Mallory-Weiss syndrome, a nontransmural esophageal tear. Diagnosis of Boerhaave syndrome can be difficult because of the classic symptoms, resulting in a delay in seeking medical care. Boerhaave syndrome is sporadic, with an incidence of 3.1 per 1,000,000 per year. We present an interesting case of a 53-year-old man who presented to the emergency department (ED) complaining of significant right-sided chest pain and diffused abdominal pain after several episodes of coughing and vomiting associated with shortness of breath and fever for two weeks. The patient was found to have COVID- 19 infection. The patient then had a chest CT without contrast, and an esophagogram was performed, which was consistent with esophageal rupture. The patient had a thoracotomy and surgical repair. This was followed by endoscopy and esophageal stent placement. The COVID-19 pandemic is a major health crisis that has drained medical resources and research capacity. Esophageal rupture is commonly due to iatrogenic causes. Transmural perforation following forceful vomiting has been termed Boerhaave syndrome. Often, it has no specific presentation, which can lead to late diagnosis, delayed treatment, and increased mortality. In this case, the early diagnosis and proper implementation of the general principles of treatment, including sepsis control, drainage, and surgical repair, led to a good outcome for the patient.