Hiccups and Psychosis: Two atypical presentations of COVID -19

Abstract The WHO defines a possible case of COVID-19 as a person experiencing fever, cough, shortness of breath and neurological signs including anosmia, ageusia or dysgeusia. However, experiences from hospitals all over the world have shown that presentations vary widely. Some atypical presentations include cardiac, gastrointestinal, neurological and cutaneous and while some are driven by the inflammatory response, other are a consequence of the hypercoagulable state. In our emergency department in a private hospital in Mexico City, we received two patients with very different symptoms on the same shift. Two previously healthy men in their 40s presented to the ER with very atypical manifestations of COVID-19. Neither of them complained of fever, cough or shortness of breath. The first referred a 3-day history of hiccups that had not resolved with metoclopramide. The second presented with an acute episode of altered mental status. While the first case revealed lung involvement of the disease, the second case had a clean chest CT scan. These cases are relevant as manifestations of COVID-19 vary widely, especially in previously healthy young adults.