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Recurrent hiccups in COVID-19 forme fruste of neuromyelitis optica spectrum disorder?

Khichar Shubhakaran

Journal of Family Medicine and Primary Care, 2022

Abstract

The case report of intractable hiccups with hyponatremia is worth considering.[1] As neurological spectrum of neuromyelitis optica spectrum disorder (NMOSD) is frequently present with intractable hiccups.[2] Recurrent hiccups are being described in COVID‐19,[3] so the infection of the novel COVID ‐19 being a pandemic is relevant everywhere, including the primary care physicians. Various neurological manifestations including hiccups and sequel in SARS‐CoV‐2[4] are being reported, so there is a fairly good possibility of this type of hiccups to be forme fruste of NMOSD or on intensive observation or evaluation we may find some associated soft or hard neurological signs supportive of NMOSD to be there in such patients. The neuroimaging, mainly the MRI, which is of course a limitation at many places in COVID‐19 pandemic, may yield some abnormalities in such patients, but examination of serum antibodies for aquaporin may give more information. As the authors have used steroids and levocetirizine for treatment, the response to steroids and levocetirizine is also there in NMOSD.[4‐5] So there is a possibility of such symptoms to be of NMOSD in such patients of SARS‐CoV‐2, and understanding this aspect may be worthwhile in understanding the spectrum of neurological syndrome in SARS‐CoV‐2. One should be watchful for intractable hiccups in patients with SARS‐CoV‐2 for NMOSD.

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