Persistent Hiccups as an Atypical Presentation of SARS-CoV-2 Infection: A Systematic Review of Case Reports

Panagiotis Giannos; Konstantinos Katsikas Triantafyllidis; Georgios Geropoulos; Konstantinos S Kechagias

doi:10.3389/fneur.2022.819624

Persistent Hiccups as an Atypical Presentation of SARS-CoV-2 Infection: A Systematic Review of Case Reports

Front Neurol. 2022 Apr 4:13:819624. doi: 10.3389/fneur.2022.819624. eCollection 2022.

Authors

Panagiotis Giannos^{1

2}, Konstantinos Katsikas Triantafyllidis^{2

3}, Georgios Geropoulos⁴, Konstantinos S Kechagias^{2

5

6}

Affiliations

¹ Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom.
² Society of Meta-Research and Biomedical Innovation, London, United Kingdom.
³ Department of Nutrition and Dietetics, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, United Kingdom.
⁴ Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London, United Kingdom.
⁵ Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.
⁶ Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.

Abstract

Symptoms, such as fever, dry cough, dyspnoea, and respiratory distress, are commonly described in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Recently, a growing number of cases pertained to persistent hiccups have been reported by SARS-CoV-2 infected patients. The aim of this systematic review was to screen the current literature and provide a summary of the reported cases of SARS-CoV-2 infected patients presenting with persistent hiccups. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and Web of Science databases were searched from inception until October 2021. Case reports or case series that provided a separate clinical description for patients with presenting complaints of persistent hiccups before or after COVID-19 diagnosis were retrieved. The critical appraisal checklist for case reports provided by the Joanna Briggs Institute (JBI) was employed to evaluate the overall quality of the eligible studies. We identified 13 eligible studies that included 16 hospitalized COVID-19 patients who complained of persistent hiccups. The mean duration of hiccups was 4.6 days reported in 88% (14/16) patients. Hypertension was the most common comorbidity present in 50% (8/16) of patients followed by diabetes mellitus (4/16). Moreover, 44% (7/16) of patients received only one medication for managing the hiccups with metoclopramide (5/16) followed by chlorpromazine and baclofen (4/16) used as primary treatment. Equally, 44% of patients (7/16) received dexamethasone followed by azithromycin (5/16), ivermectin (4/16), and ceftriaxone (4/16) for managing the infection from SARS-CoV-2. The majority of patients (14/16) improved after initiation of treatment. Persistent hiccups are possibly a rare symptom that clinicians may expect to encounter in patients infected with SARS-CoV-2. Although there is not ample proof to propose causation, increased awareness about the diversity of presentations of SARS-CoV-2 infection could be crucial in the early recognition of the disease.

Keywords: COVID-19; SARS-CoV-2; coronavirus; hiccoughs; hiccups; singultus; systematic review.

Publication types

Systematic Review