Coronavirus patients report hiccups as a surprising symptom in 2 case studies. Experts say this is no exaggeration.



  • Two case studies described unusual cases of COVID-19 in which hiccups appeared to be the only major symptom.
  • It’s possible that hiccups are a rare symptom of COVID-19, but there hasn’t been enough research to say for sure, according to medical experts.

Cook County Doctors HealthThe University of Toronto’s emergency medicine department reported an unusual case of COVID-19 in April: a patient whose main symptom appeared to be hiccups.

The 62-year-old had arrived in the emergency room after having hiccups for four consecutive days, with no idea why. He had also lost 25 pounds in four months.

Thinking the man might have a tumor between his lungs, doctors gave him a chest x-ray. Instead, the scans showed “frosted glass,” a common feature in the lungs of COVID-19 patients that makes them appear cloudy on a scan. They tested the man for COVID-19; he was positive.

A similar story unfolded in another case study published in June, which was not peer reviewed. A 64-year-old man presented to the emergency room with persistent hiccups and wheezing. His doctors took a chest x-ray, saw frosted glass patterns, and then tested the patient for COVID-19. He was positive too.

The question these two case studies explore: Is persistent hiccups a symptom of COVID-19? – does not yet have a solid answer. In addition to these two examples, the association between hiccups and the new coronavirus has not been studied much.

“My overall perspective is, it’s hard to say,” said Aparajita Singh, gastroenterologist at the University of California at San Francisco, told Business Insider, adding, “I can see why so many people would be interested in trying to research this question and trying to find an association, as hiccups are very, very common. ”

Yet, she said, the evidence available to date is “of very low quality.”

Coronavirus can irritate the digestive system

According to health news site Healthline, “Are hiccups a sign of COVID-19?” was a trending topic for weeks last month.

Singh said it’s plausible that hiccups could be a sign of COVID-19 for some patients, based on what we know about how the virus and digestive system interact.

Research has shown that the virus can cause gastrointestinal problems: One study found that out of 204 patients with COVID-19, 103 reported some kind of gastrointestinal symptom. The most common were diarrhea and loss of appetite. Six of these patients had no breathing symptoms at all – only gastrointestinal. Likewise, a CDC study found that about half of the patients had gastrointestinal symptoms, including diarrhea and vomiting.

If the coronavirus irritates the gastrointestinal tract, it can also impact the phrenic nerve, which controls the diaphragm. An irritated phrenic nerve can cause involuntary contractions of the diaphragm, also called hiccups.

“Anytime the gastrointestinal tract is affected, it’s biologically plausible that you could end up with hiccups,” Lisa Maragakis, senior director of infection prevention at Johns Hopkins Health System, told Business Insider.

Researchers still don’t know if hiccups and COVID-19 are linked

To determine for sure whether there really is a link between infection and hiccups, scientists would need more than a few case studies – ideally double-blind trials. Singh noted that in the two cases described, other factors could be at play: the man in the Cook County case study, for example, had low sodium levels, which can also cause hiccups.

None of the largest analyzes of gastrointestinal symptoms of COVID-19 so far has included hiccups. But Singh said the two case studies had piqued his interest nonetheless.

“I would pay more attention to this symptom, following the literature,” she said. “But I wouldn’t add this to my list of symptoms right away.”

Maragakis said she encouraged people with persistent and unusual symptoms, such as persistent hiccups, to “exercise caution and get tested.”

But she added that there is a fine line between being cautious and needlessly anxious.

“Once you try to be vigilant for any symptoms, each of us has questions every day,” she said.



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