Jundishapur J Microbiol. 2020 May; 13(5):e102844. Published online 2020 June 15. doi: 10.5812/jjm.102844. Case Report Gastrointestinal Presentation in a Patient with COVID-19 Without Respiratory Tract Symptoms: A Case Report From Qom, Iran Ahmad Hormati 1, 2 , Alireza Shahhamzeh 3 , Reza Aminnejad 4, 5 , Mahbobeh Afifian 6 and Sajjad Ahmadpour 1, * 1 Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran 2 Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran 3 Department of Medical Radiology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran 4 Department of Anisthesiology and Ciritical Care, Qom University of Medical Sciences, Qom, Iran 5 Department of Anisthesiology and Ciritical Care, Shahid Beheshti University of Medical Sciences, Tehran, Iran 6 Health information Technology, Tehran University of Medical Sciences, Tehran, Iran * Corresponding author: Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran. Tel: +98-9147174853, Email: sajjadahmadpour@yahoo.com Received 2020 March 19; Revised 2020 May 31; Accepted 2020 June 01. Abstract Introduction: Considering the increasing number of patients referred to gastroenterology clinics, we report a suspected case of coronavirus disease 2019 (COVID-19) with only gastrointestinal (GI) presentation in Qom, Iran. Case Presentation: A 74-year-old man with epigastric pain, diarrhea and vomiting for one week was treated, based on the routine abdominal treatment protocol. Since all GI symptoms were resistant to therapy, we decided to perform laboratory assays for a more accurate diagnosis of the disease. Considering the persistence of abdominal pain and nausea, abdominal and pelvic computed tomography (CT) scans, as well as endoscopy and colonoscopy, were performed. After performing the chest CT scan, we noticed the involvement of the lungs. The patient did not have any respiratory symptoms, and at the time of his hospitalization, the COVID-19 epidemic had been reported in Iran. With the progression of the disease, he started to experience mild fever (38°C). Using a specific COVID-19 kit, he was diagnosed with COVID-19 after precise evaluations. However, without any medications, all of his symptoms subsided after 2 - 3 weeks. Conclusions: It is important for all physicians to know that some pure GI symptoms, which are resistant to therapy, may be the only symptoms in suspected COVID-19 patients. Timely diagnosis and isolation of these patients can guarantee population to avoid the spread of this highly contagious infection. Keywords: COVID-19, Gastrointestinal Disorder, CT Scan, Pneumonia, RT-PCR 1. Introduction The global spread of the coronavirus disease 2019 (COVID-19), as a highly infectious disease, have been af- fected thousands people in all of the world (1, 2). This infec- tion has led to the death of more people than severe acute respiratory syndrome (SARS) and the Middle East respira- tory syndrome (MERS), although it has a lower fatality rate. In Iran, the ongoing COVID-19 epidemic was first reported in Qom. It is important to note that due to the COVID-19 epidemic in Iran, the number of patients, referred to our gastroenterology clinics in Shahid Beheshti Hospital, had increased by 20% (3). After the first report of this infection in Iran, all clinical evaluations, as well as treatment and clinical outcomes of patients with laboratory-confirmed COVID-19, were recorded. Considering the increasing number of patients re- ferred to gastroenterology clinics and reports of some therapy-resistant pure gastrointestinal (GI) symptoms, we suspected a case of COVID-19 in one of our patients. It should be mentioned that we encounter a large number of patients with only GI symptoms, whereas in this case report, we only documented one case, referred to our gas- troenterology clinic. Some important questions need to be addressed promptly to determine whether pure GI symp- toms appear without the incidence of respiratory disorder in confirmed COVID-19 patients. The answer to these ques- tions may lead to the effective management of the disease before affecting and transferring of SARS-CoV-2 to heath people who were in close contact with infected patients with pure GI symptoms. With this background in mind, we aimed to collect and analyze the detailed clinical fea- Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.