What is the treatment for severe pain in the upper left chest and abdomen, which radiates to the back?

Question

Hi doctor,

My brother had severe pain in the upper left chest, left abdomen pain radiating to the back, nausea, and weight loss of around 18 pounds in a week. He got admitted to the hospital due to pain. They gave him an intravenous with some painkiller in it, and he was feeling better. They performed a CT scan of the abdomen with contrast and found candidiasis in the esophagus and some erosions in the stomach antrum. They gave him an anti-fungal.

After being released from the hospital, his pain and nausea returned. Now he has a fever and chills, and COVID-19 is negative. I am attaching all his reports. Please help to diagnose the problem. He had a COVID infection last year for two weeks and took antivirals and antibiotics.

I am his sister and have developed SLE and Crohn's after a COVID infection.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed the clinical history and attached laboratory investigations (attachments removed to protect the patient's identity), including endoscopy, CT scan, and blood workup.

1) He was treated for esophageal candidiasis, but this is relatively uncommon in an otherwise healthy person, not have diabetes or immunosuppressive therapy. However, it is already treated, so one should consider the underlying cause.

2) Gallstones, if not causing acute cholecystitis inflammation, will not explain his initial symptoms, such as left-sided chest and abdominal pain. Instead, gallstones cause right upper abdominal pain.

3) I needed clarification on the reason for the neurology follow-up advised by the doctors to whom he was admitted before.

So, for nausea and vomiting,

1) He will need symptomatic treatment like before,

2) Workup of fever is important; COVID is negative, which is great, but dengue, malaria, and acute cholecystitis can be checked for recurrence of symptoms.

3) If you feel there is a recurrence of symptoms within just a few days. I recommend following up with a primary physician to optimize further treatment. The current laboratory investigations you have already sent do not explain the reason behind high-grade fever and the recurrence of symptoms.

4) It does not fit into the diagnosis of esophageal candidiasis, a few erosions in the stomach, and simple gallstones without gall bladder inflammation, as per reports.

I hope this response will help you.

Kindly revert in case of further queries.

Wishing your brother good health.

Thank you.