History

• Healthy 32 year old male presents with abdominal pain and shortness of breath
• Intermittent sharp LLQ abdominal pain for the past 2 weeks, associated with several episodes of loose stool
• Dyspnea on exertion (ie walking down the street talking) for the past 2 weeks; patient normally exercises regularly with good tolerance
• +chest tightness, denies fever, chills, chest pain, cough, LE edema. 
• Unvaccinated against COVID

Exam

Vital signs: BP: 126/73, HR = 80, RR = 16, SpO2 = 100%

• Cardiac: regular rate and rhythm, no murmurs
• Pulm: normal work of breathing, clear breath sounds with good aeration bilaterally 
• Abdomen: soft, nontender, mild distention, tenderness to palpation in LLQ 
• LE: no edema

 CT abdomen and pelvis with IV contrast

•Ovoid 2.2 cm fat density enhancing rim with inflammatory changes adjacent to the sigmoid colon, most consistent with epiploic appendagitis

• Partially imaged ground glass nodules at the lung bases

 Labs:

• COVID positive

Diagnosis: COVID and epiploic appendagits

Management:

• Ibuprofen 600 mg q8

Pearls:

• Case reports have linked epiploic appendagitis and COVID - COVID can present with abdominal pain!

• Suspect COVID in DOE in otherwise healthy young adult, even in the absence of fever or cough especially when community transmission rates are high

• Epiploic appendagitis is a benign, self-resolving condition caused by an ischemic infarct of the epiploic appendages (outpouchings of fat on the colon), due to torsion or thrombosis

• Epiploic appendagitis is found in up to 7% of cases of suspected diverticulitis

• Treat epiploic appendagitis with supportive care and Ibuprofen 600 mg q8

References:

• Subramaniam R. Acute appendagitis: emergency presentation and computed tomographic appearances. Emerg Med J. 2006;23(10):e53. doi:10.1136/emj.2005.033704

• Gelrud, A., et al. “Epiploic Appendagitis.” UpToDate. January, 2021.

• Bashari DR, Peguero-Tejada JL, Shah JI. An Atypical Presentation of COVID-19 in a Previously Healthy Young Male With a Rare Cause of Abdominal Pain. J Clin Med Res. 2020;12(9):624-628. doi:10.14740/jocmr4285