# COVID-19 Presenting With Intractable Hiccups: A Literature Review and a New Case

## TL;DR

This paper reviews cases of COVID-19 patients presenting with persistent hiccups and highlights the importance of recognizing this atypical symptom for timely diagnosis.

## Contribution

The paper presents a new case and analyzes 29 reported cases, emphasizing the association of intractable hiccups with COVID-19, particularly in older males.

## Key findings

- Persistent hiccups were the sole complaint in 31% of analyzed cases.
- Most patients were male with an average age of 58.28 years.
- Two patients died, showing the potential severity of this atypical symptom.

## Abstract

Hiccups manifest as involuntary and repetitive diaphragm contractions, often involving the intercostal muscles. However, the precise underlying mechanism remains incompletely understood but typically benign. During the COVID-19 pandemic, the predominant clinical presentation featured fever, cough, and dyspnea. However, multiple atypical presentations are increasingly recognized as manifestations of COVID-19, including refractory hiccups. This article aims to examine the shared characteristics, distinctions, notable correlations, and prognosis among COVID-19 patients presenting with intractable hiccups. Additionally, we present a 79-year-old male with a history of Parkinson’s disease, hypertension, and diabetes who presented with refractory hiccups, cough, and a runny nose. Laboratory analysis revealed elevated inflammatory markers and a positive COVID-19 test. The patient responded well to medical management, and the hiccups were resolved.

Notably, the association between persistent hiccups and COVID-19 infection is increasingly recognized, predominantly affecting older males with comorbidities and can be the sole complaint. Furthermore, we analyzed 29 cases of COVID-19 with persistent hiccups in the English literature. The mean duration of symptoms was 3.9 days with the majority of these cases being males (96.55%) and an average age of affected individuals of 58.28 years. Cough was the most frequently associated symptom (31.03%), while an equal proportion of patients (31.03%) reported intractable hiccups as their sole complaint. Additionally, common findings included elevated inflammatory markers, electrolyte imbalances, and infiltrates on imaging. Most of the patients demonstrated substantial improvement through symptomatic and medical management; however, mortality was documented in two cases, which highlights the potential for this seemingly benign manifestation to mislead and necessitate thorough evaluation upon presentation.