Therapeutic challenges of extrapulmonary dual organ system involvement in COVID-19: A case report

Respiratory symptoms and signs remain the hallmark of coronavirus disease 2019 (COVID-19) infection. However, extrapulmonary manifestations of COVID-19 are not uncommon, and are likely to be underreported. The present study describes a clinical case of a 64-year-old patient with COVID-19 with marked extrapulmonary manifestations in the setting of strong positive reactions with cycle threshold values of reverse transcription polymerase chain reaction for COVID-19. He presented with asymptomatic bradycardia with wide pulse pressure, eventually requiring transvenous cardiac pacing. He later complained of lower abdominal pain associated with no bowel movements for four days. The computed tomography examination of the abdomen revealed circumferential wall thickening at the proximal ascending colon, suggestive of inflammatory changes and features of obstruction in the presence of inguinal hernia. Despite aggressive resuscitative efforts, the patient continued to deteriorate with multiorgan failure, and eventually succumbed to the disease after 6 days of hospitalization. The present case study deliberates the sharing of our clinical experience and therapeutic challenges in the management of COVID-19 with complex extrapulmonary manifestation.