38 CLINICAL FOCUS
38 CLINICAL FOCUS
2 JUNE 2023 ausdoc . com . au
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Case report
A COVID-19 complicated case
Pandemic hold-ups hamper identification of the cause of this patient ’ s persistent gastrointestinal symptoms after SARS-CoV-2 infection .
Dr Carl D ’ Souza Junior medical officer at Fiona Stanley Hospital , Perth , WA .
Dr Daniel Xu Academic co-ordinator , general practice research and international health , Curtin Medical School , Curtin University , Perth , WA .
MARK , a 29-year-old electrician presents to his GP with six episodes of cough , wheeze , yellow sputum and abdominal bloating over the past four months . He has had asthma since the age of eight , which has previously been controlled well with inhaled budesonide / formoterol 200 / 6 bd . He has no other known medical comorbidities and does not drink alcohol or smoke .
At initial presentation the clinical findings are consistent with an infective exacerbation of asthma , so Mark is prescribed antibiotics , a three-day course of prednisolone 50mg and an increased dose of budesonide / formoterol 400 / 12 bd .
Progression
Two weeks later , after resolution of his symptoms , Mark has a seventh episode , also associated with his usual cough , yellow sputum and abdominal pain . This time , however , he also has some diarrhoea and has tested positive for COVID-19 via PCR . For this , he is prescribed molnupiravir 800mg bd , and in view of his recurrent chronic moderate-to-severe asthma , is given a five-day course of Augmentin Duo Forte 875mg bd and prednisolone 50mg .
Another two weeks later , Mark ’ s typical symptoms of infectious exacerbation of asthma have resolved . However , he has developed foul-smelling diarrhoea with blood and mucus . He has new oral aphthous ulcers , as well as ongoing abdominal pain and bloating . He notes that when he was taking the prednisolone , his gastrointestinal symptoms had been significantly better .
On examination , Mark has a low-grade fever of 37.7 ° C with otherwise normal vital signs . His BMI is 21kg / m 2 . The abdomen is soft with mild generalised tenderness on palpation , no rebound tenderness and normal bowel sounds . Heart sounds are dual
with nil added sounds , the chest is clear , and all other examination is unremarkable .
Repeat COVID-19 RAT and PCR tests are negative .
At this time , the possible diagnoses considered include : post-COVID-19 viral gastroenteritis , Clostridium difficile , inflammatory bowel disease ( IBD ) and other causes of colitis .
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