QUESTION: A 48-year-old man visited our hospital complaining of abdominal pain, nausea, and general weakness. The patient has no special medical history other than the fact that he was treated for 2019 coronavirus (COVID-19) a month ago and receiving chemotherapy for colorectal cancer. He received conservative treatment at the time of treatment for COVID-19, and after receiving hospitalization for a week, his symptoms improved and he was discharged. Two weeks later, when he visited the pulmonology department at our hospital, he complained of nausea along with intermittent pain in the epigastric region, and was referred to the gastroenterology and hepatology department.

There were no specific findings on blood tests and computed tomography scans of the chest and abdomen. Therefore, we performed esophagogastroduodenoscopy (Fig. 1) and Total colonoscopy (Fig. 2) to try to determine if there were any other problems. However there were no specific findings other than traces of gastric ulcer on stomach body in the two endoscopic examinations, and the patient continued to complain of intermittent symptoms.

Figure 1. Esophagogastroduodenoscopy.

Figure 2. Total colonoscopy.

What is the diagnosis for this case?

ANSWER: Long covid syndrome.

REVIEW: During the COVID-2019 pandemic, numerous patients recovered from severe coronavirus 2 acute respiratory syndrome (SARS-Cov-2) infections. However, even after recovery, patients with a wide variety of symptoms have been reported, and they are expressed in terms such as ‘Long Covid’, ‘Post-COVID condition’, and ‘Post acute sequalae of SARS-Cov-2 infection’. These symptoms may appear similarly after recovery from other sepsis or viral infections. In particular, digestive cancer patients may have more connections with Long Covid symptoms due to surgery, chemotherapy, poor physical condition, etc., and to cope with these patients, we want to find out about the symptoms suspected of Long Covid [1].

COVID-19 appears 4 weeks after infection, and E. coli is very absent even on the normal side, affecting the lives of acute patients who have lasted more than 2 months. Long Covid symptoms appear in a variety of physical and mental aspects, sometimes lasting for more than 2 months, affecting the patient’s life and often not being clearly diagnosed with conventional examination methods. Although the clinical diagnosis criteria for Long Covid have not yet been established, a diagnosis code was generated as an unspecified post-COVID condition (U09.0) in ICD-10 in October 2021. The World Health Organization operates a site to understand cases by creating a global COVID-19 clinical platform case report form [2].

Fatigue (13–87%), shortness of breath (10–71%), chest pain (12–44%), and cough (17–34%) are common as the main Long Covid symptoms. Mental sequelae such as anxiety (22%), depression (23%), post-traumatic stress syndrome (24%), memory loss (18–21%), attention deficit (16%) may also suffer. In rare cases, symptoms such as loss of smell, joint pain, headache, dry mouth, rhinitis, loss of taste, loss of appetite, dizziness, muscle pain, insomnia, voice change, hair loss, sweating, decreased libido, and diarrhea are experienced. About half of patients experience a decrease in quality of life [3].

Nausea and diarrhea symptoms may appear as digestive symptoms among the symptoms of Long Covid, and they gradually improve. However, if symptoms worsen or develop new, antibiotic-induced diarrhea or Clostridium difficile enteritis should be considered. Patients may experience weight loss, malnutrition, loss of appetite, difficulty swallowing, and changes in taste and smell. At this time, the medical staff should educate and support patients to eat small amounts of frequent meals and to supplement and consume appropriate amounts of protein and calories.

Even in treating digestive cancer patients, it is necessary for medical staff to pay attention to the difficulties that patients experience with Long Covid symptoms and the degree to which they cause difficulties in daily life, and to support them so that they can gradually recover and to perform rehabilitation if necessary. We need to ensure that appropriate action is taken.

None.

No potential conflict of interest relevant to this article was

reported.

Conceptualization: Eun Sun Kim. Data acquisition: Eun Sun Kim. Formal analysis: Eun Sun Kim. Supervision: Eun Sun Kim. Writing—original draft: Young Cheon Ra. Writing—review & editing: Young Cheon Ra.