Intractable Singultus: Atypical presentation of COVID 19

Singultus are involuntary manoeuvre that involve the reflex arc of swallowing and can be further divided into acute singultus ( 48hours). We present a case series of three patients of different age groups who presented with the chief complaint of persistent hiccup not responding to treatment. Other than Hiccup which was episodic physical examination of the patient were unremarkable. However, Reverese Transcriptase Polymerase Chain Reaction for COVID-19 was Positive and High-Resolution CT Scan of the Chest was able to demonstrate Ground Glass Opacities scattered throughout the lung. The patients did not respond to primary treatment for hiccups and were treated with antiviral and other supportive measures. All the three patients recovered and were later discharged in stable condition. Thus, this case series showcases the importance of keeping COVID-19 as an important differential diagnosis of persistent hiccup to be prompt in reaching the diagnosis in this atypical presentation but to also be vigilant of unexpected exposure for the physician himself.