Extra Pulmonary Manifestations of COVID-19: A Narrative Review

Coronaviruses are a large family of viruses that usually cause mild to moderate upper respiratory tract illnesses. The newly emerged sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in late 2019 and causes coronavirus disease 2019 (COVID-19). Due to the novelty of the virus, new scientific evidence on various aspects of COVID-19 is reported in the literature continuously.Common symptoms of COVID-19 include fever, dry cough, fatigue, myalgia, arthralgia and Shortness of breath. Some articles have also reported on various manifestations of SARS-CoV-2 infection outside the respiratory tract. The affected organs are gastrointestinal tract, central nervous system, skin, olfactory system, cardiovascular system, liver, kidney and eye.The summary of extra pulmonary involvements by COVID-19 are anosmia, ageusia, erythematous rash, chickenpox-like blisters, acute cardiac injury with increased cardiac troponin levels, inflammation and edema of the renal parenchyma, gastrointestinal symptoms such as diarrhea and vomiting, abnormal liver function with increased levels of alanine and aspartateaminotransferase and neurologic symptoms ranging from headache to stroke. The hypothetical pathophysiologic mechanisms of systemic manifestations of COVID-19 are overproduction of cytokines (cytokine storm), hypoxemia, direct SARS-CoV-2 damage or combination of these mechanisms. Further studies are needed to demonstrate the relationship between outcome of COVID-19 and pathogenesis.