[46M] Experiencing post-COVID long-term symptoms

Vomiting

Differential diagnosis

• More likely given the history of post-exertional symptoms are post-exertional malaise (G93.3), and chronic fatigue syndrome (R53.82)
• Less likely but possible given the symptomatology are gastrointestinal disorders such as GERD (K21.9), peptic ulcer disease (K27.9), and gastroparesis (K31.84)

Plan

Perform a physical exam and order a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid function tests. Consider referral to a gastroenterologist for further evaluation if symptoms persist.

Cognitive Impairment

Differential diagnosis

• Most likely given the history of post-COVID symptoms is post-acute sequelae of SARS-CoV-2 infection (PASC) (U09.9)
• Other possibilities include early onset dementia (G30.0), depression (F32.9), and chronic fatigue syndrome (R53.82)

Plan

Perform a cognitive screening test such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA). Consider referral to a neurologist or psychiatrist for further evaluation.

Joint Pain

Differential diagnosis

• Most likely given the history of post-exertional symptoms are fibromyalgia (M79.7), rheumatoid arthritis (M06.9), and osteoarthritis (M15.9)
• Less likely but possible given the symptomatology are Lyme disease (A69.20), and lupus (M32.9)

Plan

Perform a physical exam focusing on the joints. Order a rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) test to rule out rheumatoid arthritis. Consider referral to a rheumatologist for further evaluation if symptoms persist.

Insomnia

Differential diagnosis

• Most likely given the history of chronic symptoms are chronic insomnia (G47.00), and sleep apnea (G47.30)
• Less likely but possible given the symptomatology are restless leg syndrome (G25.81), and circadian rhythm sleep disorder (G47.20)

Plan

Perform a physical exam and consider ordering a polysomnography to rule out sleep apnea. Consider referral to a sleep specialist for further evaluation if symptoms persist.

Fatigue and Weakness

Differential diagnosis

• Most likely given the history of post-COVID symptoms is post-acute sequelae of SARS-CoV-2 infection (PASC) (U09.9)
• Other possibilities include chronic fatigue syndrome (R53.82), depression (F32.9), and anemia (D64.9)

Plan

Perform a physical exam and order a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid function tests. Consider referral to a psychiatrist for further evaluation if symptoms persist.