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.