Introduction: The main symptoms of new coronavirus in patients are fever or chills, tiredness, and dry cough. In this case, we reported a woman who got involved in COVID-19 pneumonia with gastrointestinal instead of lower respiratory symptoms.
Case Presentation: A 67 years old woman was referred to an outpatient clinic in Tehran with fever, chills, sneezing, tiredness, severe nausea, anorexia, and diarrhea. She did not have a cough, dyspnea, or chest pain and her lung sound was normal. According to the blood O2 saturation decreasing, C-reactive protein increasing, and the lung imaging findings, she was admitted with COVID-19 pneumonia diagnosis in the infectious care department of a hospital. The 2019-nCoV real-time polymerase chain reaction (PCR) intranasal assay was negative. She was treated with intranasal oxygen therapy, anti-inflammatory drugs, and prednisone. After one week she was discharged in generally good condition and quarantined for two weeks later. After 25 days the COVID-19 IgM and IgG antibodies were in positive ranges.
Conclusion: Severe fatigue, mainly in elders caused the inability to cough, and light inspiration force especially in the lower lung lobes could explain the normal lung sounds in the physical examination. Also, we hypothesized that reverse circulation of the virus may occur from the gastro intestine to the respiratory system. The gut-lung microbial imbalance may affect the severity in patients with extrapulmonary symptoms, especially in old ages. Furthermore, damage to the vagus nerve along the path in the proximity to lungs infected with COVID-19 can cause nausea without gastrointestinal involvement.