INTRODUCTION: In early 2020, an outbreak of COVID-19 spread exponentially throughout the world causing a pandemic, with more than 3 million cases and more than 230,000 deaths both of which continue to rise. While the primary presentation has been fevers, cough, myalgias, and possible pneumonia, there have been some reports of gastrointestinal (GI) symptoms such as diarrhea in an estimated 1 to 10% of patients. This is a case of a patient who presented with primarily GI symptoms and was discovered to be COVID-19 positive. CASE DESCRIPTION/METHODS: A 93 year old Caucasian male from Massachusetts, with no history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), immunosuppression, recent travel, or sick exposure, presented with a subacute onset of nausea, vomiting and diarrhea. He reported 4–6 episodes per day of non bilious vomiting, and 8–10 episodes of large volume, watery, non-bloody diarrhea. Labs showed WBC 6,000/mL, mild lymphopenia 300/uL, hemoglobin 9gm/dL, hypokalemia, hypomagnesemia, CRP elevated to 24, and ESR of 8. Stool studies and blood cultures were negative, and he improved with supportive measures. On the third day of admission upon discharge, he developed hypoxia without SOB, cough, or fevers. CT angiography of the chest was then performed that showed multiple ground glass opacities (Figures 1-3). Rapid respiratory panel and influenza testing were negative, but SARSCOV2 PCR testing returned positive. He was treated with azithromycin 500mg for 5 days and hydroxychloroquine 400 mg twice daily by mouth for two doses, then 400 mg daily for 3 days. He was then discharged with strict self-quarantine orders. Follow-up labs in 2 weeks showed persistent leukopenia and lymphopenia, but otherwise he was afebrile with no new symptoms. DISCUSSION: While the primary symptoms of COVID-19 are respiratory, there have been increasing reports of diarrhea with one study demonstrating the presence of the virus in stool samples of 50% of COVID-19 patients. The pathophysiology is less understood, but revolves around angiotensin cleaving enzyme-2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) found in high concentrations along the tract, which may be required for COVID entry into the GI tract leading to inflammation. This case adds to the increasing evidence of COVID induced GI inflammation, and it is vitally important to institute precautions against COVID-19 infection in patients that may present with primarily GI symptoms, especially in the midst of this pandemic.Figures 1-3.: Diffuse, fine, ground glass opacities seen in hilar and mediastinal regions.