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.