The 2019 novel coronavirus disease (COVID-19) has become a global health crisis since its initial outbreak. Besides the typical manifestations of fever, respiratory symptoms, myalgia, lymphopaenia and radiological evidence of pneumonia, asymptomatic infections have also been reported [1]. With presumed asymptomatic transmission of COVID-19 during the incubation period [2], prevention of widespread transmission is challenging. In view of the massive burden on medical systems worldwide caused by the outbreak [3], as well as reports of postoperative pulmonary complications and higher mortality in patients with perioperative COVID-19 [4], most elective surgeries have been postponed. However, evidence regarding patients with COVID-19 and concomitant conditions requiring urgent surgical interventions remains scarce. The principle concern is to balance the benefits of timely surgical management against the risks of complications resulting from perioperative COVID-19 [5].

We report the case of an individual considered high risk for COVID-19, but had a previous negative swab and no respiratory symptoms, who developed acute suppurative appendicitis and was subsequently found to be positive for the coronavirus SARS-CoV-2 after appendicectomy.

A previously well 25-year-old Bangladeshi male staying in a foreign worker dormitory (FWD) in Singapore, presented with a three-day history of fever, abdominal pain, vomiting and diarrhoea. His abdominal pain started in the epigastrium and migrated to the right iliac fossa (RIF). No symptoms of an acute respiratory illness (ARI) were present. Table 1 summarises his sociodemographic and clinical characteristics. His FWD was not labelled as a COVID-19 cluster by the Ministry of Health (MOH) and he had a negative SARS-CoV-2 polymerase chain reaction (PCR) nasopharyngeal swab 14 days ago. Since then, he only ventured out of his dormitory room to collect food or use the common lavatory.

The patient presented with a fever of 38.1˚C and a pulse rate of 112 beats per minute. Blood pressure was 121/76mmHg and he had an oxygen saturation of 98% on room air. Significant physical findings included clinical signs of dehydration and RIF tenderness with generalised abdominal guarding. Examination of the lungs revealed equal bilateral air entry and no adventitious lung sounds. Laboratory investigations showed haemoglobin level of 16.5 g/dL and leukocyte count of 15.1 × 10³/uL with neutrophilia (86.2%). Absolute lymphocyte count was normal at 1.2 × 10³/uL. There was evidence of acute kidney injury (AKI), with an estimated glomerular filtration rate of 56 ml/min/1.72m² and serum creatinine was 148 umol/L. His chest X-ray did not show any abnormality.