How to manage Norovirus infection in Crohn’s disease?

Question

Hello doctor,

My 21-year-old son, who has Crohn's disease, caught norovirus from his college dorm four days ago. It started with projectile vomiting and explosive diarrhea, which has continued with minimal improvement. He is having 15 to 20 watery bowel movements daily, with visible blood and mucus.

The abdominal pain is severe, rated nine out of ten, despite taking his prescribed Oxycodone. Despite taking Acetaminophen, he has had a persistent fever between 101-103° Fahrenheit. He is on Humira (Adalimumab) for Crohn's disease, which he was due to inject yesterday, but we held off on it due to the infection. He also takes Azathioprine daily, which he has not been able to keep down.

I am very concerned this could trigger a severe Crohn's flare, as he was finally in remission after years of struggling. He is showing signs of dehydration, including dry lips, decreased urination, and dizziness when standing. He has lost eight pounds since this started. We tried ondansetron, which helped slightly with the nausea but caused a severe headache. Last night, he vomited what looked like coffee grounds, which scared us.

His heart rate is consistently elevated, around 115 to 120 beats per minute, and his blood pressure was 95/65 mm Hg this morning, which is low for him. The campus health center said it's just a virus, but I am concerned it is becoming complicated by his Crohn's disease.

Should we take him to the emergency room, or should we try to manage this at home?
How long should viral symptoms last before suspecting a Crohn's flare?
Should he take his biologics during an active infection?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Kindly tell me if Crohn's disease is well controlled with the medications.

Norovirus infection is a self-limiting infection, lasting for four to five days, which needs treatment for symptoms only. But norovirus can have severe symptoms if you have Crohn's disease or any other form of IBS (inflammatory bowel disease).

Generally, immunosuppressants are given for Crohn's disease. But these immunosuppressants flare off any GIT- gastrointestinal tract infection. Hence you must consult with your GI specialist and drop this dose of immunosuppressant. Next to the next Humair can be taken on time. About Azathioprine, kindly consult your GI specialist. It can also be stopped for a while.

In norovirus infection, dehydration is the main concern. Dehydration could be serious if water intake is not maintained.

Signs of severe dehydration

Lethargy or less activity than usual.
Pale and sunken eyes.
Cold hands or feet.
Faster breathing and heart rate.
Irritability, drowsiness, or confusion.
Dark yellow pee or less frequent urination.
Reduced skin elasticity.

If any of these signs persist even with maintaining hydration, please go to the emergency room.

Symptoms must subside within four to five days. Due to Crohn's disease, you might have prolonged recovery up to 10 to 12 days. If you notice any intermittent diarrhea after the complete remission of current norovirus symptoms, then it could be an infection IBS. If you notice such episodes, kindly consult your GI specialist for further management.

Advice

ORS (oral rehydration salts), increased fluid intake, and avoid sugary drinks.
Antiemetics is like a modem for vomiting.
Imodium for diarrhea.
Anti-spasmodic like Cyclopam (Dicyclomine and Paracetamol).
Eat easy-to-digest food items like rice, soups, toast, and fruits which do not flare up your Crohn's disease symptoms.
Yogurt to maintain normal gut flora if well tolerated by your gut.
Multivitamin supplements after consulting a GI specialist.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.