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The hiccups improved, and the patient was discharged home after ten days. Physicians should maintain a high level of suspicion and be aware of atypical presentations of COVID-19. Physicians should maintain a high level of suspicion and be aware of atypical presentations of COVID-19.Adenosine kinase (ADK) deficiency is characterized by liver disease, dysmorphic features, epilepsy and developmental delay. This defect disrupts the adenosine/AMP futile cycle and interferes with the upstream methionine cycle. We report the clinical, histologic