Case History/Examination
An 86-year-old male presented to the ER with severe watery diarrhea, up
to 6 episodes per day, of 1 month duration. The patient’s diarrhea was
non-bloody and non-mucoid. He denied fever, nausea, vomiting, abdominal
pain, bloating, loss of appetite, or anal itching. There was no history
of weight loss, fatigue, or systemic symptoms.
The patient reported that his Parkinson’s disease symptoms, including
tremors and motor function, had worsened over the past month concurrent
with the onset of diarrhea. Despite taking a full course of
ciprofloxacin and metronidazole 1 week prior to presentation, there was
no improvement in his symptoms. The diarrhea was also unresponsive to
loperamide.
The patient had several comorbidities, including hypertension, diabetes
mellitus, Parkinson’s disease, benign prostatic hyperplasia, and
coronary artery disease (s/p 7 stents), managed with medications
including amlodipine, irbesartan, moxonidine, carvedilol, methyldopa,
carbidopa-levodopa, pramipexole, insulin glargine, tamsulosin, and
clopidogrel.
Physical examination revealed a soft, non-tender, non-distended abdomen
with positive bowel sounds in all four quadrants. The rest of the
physical exam was unremarkable with regular heart sounds and good
bilateral air entry in the lungs.