Introduction: Most COVID-19 infections present with respiratory symptoms yet gastrointestinal symptoms have been increasingly reported prior to the onset or in complete absence of respiratory symptoms Common symptoms noted include loss of appetite, nausea, vomiting, abdominal pain and diarrhea. There are few cases of COVID-19 related colitis in the current literature. We present a rare case of COVID-19 colitis with the atypical presentation of persistent hiccups. Case Description/Methods: A 57 year old male with a PMHx of HTN, Parkinson’s disease, stroke and localized colorectal adenocarcinoma presents to our institution with persistent hiccups and hypotension. The patient was started on chemotherapy (Capecitabine + Oxaliplatin) 3 weeks prior. In the last 7 days, he had GERD, nausea, anorexia, mild abdominal discomfort and diarrhea. Initial laboratories recorded mild microcytic anemia, and acute kidney injury. He was started on IV hydration. Results were negative for C. difficile toxin, rotavirus, stool fat, stool leukocytes, ova/parasites, and negative growth in cultures. Hypotension resolved after 24 hours. Despite treatment, he continued with hiccups, abdominal pain and PO intolerance. The patient suffered respiratory failure secondary to aspiration due to hiccups; and was placed on MV for 24 hours. At this point, COVID-19 PCR pharyngeal swab returned positive. Abdominopelvic CT scan was performed due to persistent symptoms, demonstrating edematous ascending colon and distal ileum consistent with colitis. Further work-up revealed normal pH and lactic acid levels. He was placed on NPO and IV antibiotics. After 14 days, the patient was discharged. Discussion: Both gastrointestinal (GI) symptoms and hiccups have been reported as atypical presentations of COVID-19 infection previously, but not concomitantly and even separately, rarely. Physicians must be suspicious of GI symptoms, with persistent hiccups, in the pandemic in order to diagnose COVID-19 infection and avoid further GI complications including ischemic, ileus and perforation; or the onset of severe respiratory complications.