S1739 Unresolved Diarrhea in a Coronavirus Disease 2019-Infected Patient

Abstract

INTRODUCTION: Although coronavirus disease 2019 (COVID-19) primarily manifests respiratory symptoms, 10% of COVID-19 patients develop gastrointestinal symptoms. However, it is unknown if providers should investigate other infectious gastrointestinal etiologies in COVID patients. The purpose of this case was to illuminate on other enteric organisms that may coincide in COVID patients with gastrointestinal symptoms. CASE DESCRIPTION/METHODS: An 82 year-old male with a past medical history of type 2 diabetes mellitus, hypertension, and prostate cancer, presented to the emergency department secondary to hypoxia. Although he tested positive for COVID-19 three days before presentation, he acknowledged dyspnea and small volume watery diarrhea on presentation. Physical examination was normal. Since he required oxygen, he was admitted for respiratory failure secondary to COVID-19. Pertinent positive laboratory findings included a normocytic anemia, decreased absolute lymphocyte count, and elevated d-dimer (6,474 ng/mL), fibrinogen ( >1,000 mg/dL), procalcitonin (0.52 ng/mL), and C-reactive protein (214 mg/L) whereas pertinent negatives included no leukocytosis and negative blood cultures. Chest x-ray reported bilateral pulmonary opacities. Although his oxygen requirement improved, he continued to have diarrhea; therefore, other infectious etiologies were investigated. Clostridium difficile stool testing and stool culture for Salmonella and Shigella were negative whereas Campylobacter stool antigen was positive. Azithromycin was started for Campylobacter with no evidence of QT prolongation alongside hydroxychloroquine. Once weaned to room air and diarrheal resolution, he was discharged after an eleven day hospital admission. DISCUSSION: Although providers test for COVID-19 relative to a patient’s respiratory symptom, the medical community are beginning to test for COVID-19 relative to a patient’s gastrointestinal symptoms. It is now well established certain gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain are associated with COVID-19. Therefore, providers presume a patient’s diarrhea is secondary to COVID-19. However, such symptom could be due to other pathologic organisms such as Clostridium, Salmonella, or Campylobacter. Although the rate of gastrointestinal infections coinciding with COVID-19 is not well known, providers could evaluate for other enteric organisms causing unresolving gastrointestinal symptoms in COVID-19 patients.