Researchers at the University of Virginia have presented with a case series that suggests a potential association between infection with SARS-CoV-2 and the development of acute appendicitis in children. The researchers have described four cases of children aged 11-17 years presenting with acute appendicitis symptoms who were also found to be COVID-19 positive.
The patients include a 17-year-old boy with abdominal pain, vomiting, and nausea; a 14-year-old boy with abdominal pain, diarrhea, and vomiting, a 13-year-old boy with abdominal pain, vomiting, and nausea; an 11-year-old girl with abdominal pain, fever, and vomiting. A CT scan of the pelvis revealed a dilated and fluid-filled appendix and fat stranding consistent with edema and acute inflammation. PCR test of nasopharyngeal swab samples was positive for SARS-CoV-2.
The researchers opined that there are several reasons for acute appendicitis associated with COVID-19. GI symptoms occur frequently in children with COVID-19 and persistent viral infection of the GI tract has been observed in COVID-19 cases. ACE-2 receptors are also expressed at high levels in the intestinal lining. The researchers encourage testing for COVID-19 in pediatric patients presenting with GI symptoms.
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