Background: The accuracy of routine nasopharyngeal (NP) COVID19 testing in patients without respiratory symptoms is unknown . We describe a patient who presented with only gastrointestinal symptoms who tested negative twice, highlighting a variation of this disease that may be more difficult to defect by standard testing . Case: A 17-year-old boy presented with 5 days of abdominal pain, headaches, vomiting and fevers . He was initially evaluate at another hospital where an NP swab was negative for COVID19 . On presentation to our facility he had clinical signs of sepsis . Small bowel edema and ground glass consolidations were seen in both lung bases on CT. A second COVID19 NP test was negative . Sputum PCR testing was performed and ultimately returned positive . The patient eventually recovered and was discharged home .
Discussion: A high index of suspicion for COVID19 must be maintained in the face of diagnostic uncertainty given the variable presentation of this disease . sIn patients who present with GI-predominant symptoms, accuracy of standard testing may be lower.