Severe COVID-19 initially presenting as mesenteric adenopathy

Coronavirus disease 2019 (COVID-19) can present with abdominal pain in children and adults. Most imaging findings have been limited to characteristic lung findings, as well as one report of bowel-ischemia-related findings in adults. We report a case of COVID-19 in a healthy teenager who initially presented with isolated mesenteric adenopathy, typically a self-limited illness, which progressed to severe illness requiring intensive care before complete recovery. The boy tested negative for COVID-19 twice by polymerase chain reaction (PCR) from upper respiratory swabs before sputum PCR resulted positive. A high index of suspicion should be maintained for COVID-19 given the continued emergence of new manifestations of the disease.

Automated summary

COVID-19 can present with abdominal pain in children and adults, requiring high suspicion. A case involving a healthy teenager initially showing isolated mesenteric adenopathy progressed to severe illness. Prior negative upper respiratory swab PCR tests before positive sputum PCR highlights the need for ongoing vigilance for new manifestations of the disease.