2.2 Differential diagnosis
Otolaryngological examination to investigate other comorbidities related
to asthma exacerbation revealed that the patient had no eosinophilic
sinusitis but had bilateral chronic sinusitis and right secretory otitis
media, which were treated with antibiotics. Other infections were
excluded, and there were no significant bacterial findings. Serum
aspergillus/cryptococcal/candida-mannan antigen and β-D-glucan tests
were negative. Although the patient had oral candidiasis, it was not a
cause of asthma exacerbation. The SARS-CoV-2 nucleic acid test results
were negative.
Computed tomography showed no signs of pneumonia, exacerbation of
interstitial pneumonitis, pulmonary embolism, or acute respiratory
distress syndrome.
She had acetaminophen after COVID-19 vaccination; however, she did not
have a history of allergy to drugs, including nonsteroidal
anti-inflammatory drugs (NSAIDs). In addition, the patient did not have
any obvious contact with potential allergens. Anaphylaxis was considered
in the differential diagnosis, but other cutaneous and mucosal symptoms
were absent.
She had not experienced asthma exacerbation during the previous decade.
Accordingly, her adherence was not the cause of the asthmatic crisis. In
this case, we did not administer adrenaline before the diagnosis of TTC;
hence, adrenaline use was not involved in the onset of TTC.
Therefore, we consider that her status asthmaticus was enhanced by the
COVID-19 vaccination and not by infection, allergic reactions, or
medication.