Unusual Extra Pulmonary Clinical Manifestation as Initial Presenting Feature of COVID-19 and its Management: A Systematic Review of Case Reports

Corona virus disease 2019 (COVID-19) is primarily an infectious disease of the respiratory system. COVID-19 might have unusual extra pulmonary clinical manifestations as initial symptoms. This systematic review included case reports published from January 2020 to June 2022 in English language that met the following criteria: unusual clinical manifestations as a sole or first initial manifestation of COVID-19, Confirmed positive Reverse Transcription Polymerase Chain Reaction (RTPCR) and real time RTPCR COVID-19 patients, no history of pre-existing co morbidities or any family, past, personal history and complete details of patients with their management. All the case reports were identified in PubMed and Sciencedirect database. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 14537 studies were screened and 46 case reports were included in this review. In 46 case reports, there were 49 patients (three case reports had two patients) in which 32 were males and 17 were females. Majority of the patients experienced neurological manifestations followed by gastrointestinal manifestations, haematological manifestations and ocular manifestations. Health care professionals should be aware and alert about unusual extra pulmonary clinical manifestations of COVID-19 patients; this would help in making timely diagnosis and accurate treatment of COVID-19 patients.