COVID-19 associated anorexia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Overview

Anorexia is the loss of appetite and may be due to a number of reasons. It may be associated with other symptoms such as abdominal pain, nausea and fever. Anorexia associated with COVID-19 must be differentiated from other diseases such as hepatitis, Ulcerative colitis, Crohn's disease and Chronic underlying disease-associated anorexia.

Anorexia associated with COVID-19 must be differentiated from other diseases that cause anorexia such as:^[1]^[2]


Disease	Differentiating features
Hepatitis	Acute hepatitis especially autoimmune hepatitis shared common symptoms such as fatigue, abdominal pain, nausea, vomiting, diarrhea, skin rash. Some hepatic infections may involve pleuritis and pleural effusion thus chest pain.
Crohn's disease	Crohn's disease may have a history of remissions and relapses Present with symptoms shared by COVID-19 infection as well especially during a relapse. Other symptoms of Crohn's disease include abdominal pain, diarrhea that may or may not be bloody, fever and rash. History of Crohn's disease can help on deciding on the differential diagnosis but it is equally important to access possible COVID-19 infection. Patients should be counseled about the similarities in two diseases.
Ulcerative colitis	A relapse can have symptoms similar to COVID-19 such as: abdominal pain ,diarrhea, rash. A history of ulcerative colitis is important it is equally important to access for possible COVID-19 infection. Patients should be counseled about the similarities in two diseases.
Chronic underlying disease-associated anorexia	Cancer patients have anorexia and are an increased risk of COVID-19 infection itself. High suspicion is required and the patient should be tested for COVID-19 infection if required.

↑ Occhipinti V, Pastorelli L (May 2020). "Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a "Red Zone" Area in Northern Italy". Inflamm. Bowel Dis. 26 (6): 793–796. doi:10.1093/ibd/izaa084. PMC 7188155 Check |pmc= value (help). PMID 32314792 Check |pmid= value (help).
↑ Ponnurangam Nagarajan V, Palaniyadi A, Sathyamoorthi M, Sasitharan R, Shuba S, Padur Sivaraman R, Scott JX (2012). "Pleural effusion - An unusual cause". Australas Med J. 5 (7): 369–72. doi:10.4066/AMJ.2012.1024. PMC 3413004. PMID 22905065.