It was overused of acetaminophen eventually led to Nic Petermann’s cancer diagnosis. For months, the then 26-year-old had to deal with exhaustion, night sweats, recurrent fevers and stomach ache that kept her from waking up in the middle of the night for a soothing bath. Her persistent flu-like symptoms, she read online, were probably just the lingering consequences of the Covid infection she contracted in January 2021; pain was a strange symptom, but the ultrasound was fruitless.
By June, the pain was too much to bear — Petermann called the telehealth hotline and was immediately transported to the hospital after staff heard how much acetaminophen she had taken. After extensive testing, Petermann finally had the answer: All of her symptoms, including those that appeared to be persistent Covid, were caused by Stage IV Hodgkin lymphoma. She started chemotherapy the next day.
Today, Petermann is in remission, although she still faces the long-term consequences of months-long aggressive chemotherapy. Had she not attributed most of her symptoms to prolonged Covid, she said, she could have received appropriate treatment and a diagnosis much earlier. “When I went to get my pain symptoms checked, I didn’t mention the flu-like symptoms, because I just thought it was something that I was going to have to deal with,” she said.
Most people with Petermann’s symptoms will not end up in her place. Long Covid is common — an estimate of its prevalence very different, but even the most conservative studies imply that millions of people are facing symptoms of their infection that persist. On the other hand, Hodgkin lymphoma is very rare. But with dozens of possible symptomsLong-term Covid can be easily confused with a multitude of other conditions, including cardiovascular diseases such as hypertension and diabetes, autoimmune diseases such as lupus and multiple sclerosis, and cancer. Add the fact that Covid can make existing conditions worse, and determining if someone is staying Covid is a difficult task.
Parsing this series of alternatives has become the responsibility of clinicians on the vanguard of long-term Covid care, from the primary care physicians a patient looks to at the outset. first to the professionals who staff the long-term Covid clinics. For each patient, they must perform a careful differential diagnosis, a medical term that refers to the process of looking at every possible cause for a patient’s set of symptoms.
An accurate differential diagnosis is essential not only for patient care but also to advance medical understanding of a condition that remains largely unknown. “We need to be careful not to turn long-term Covid into a comprehensive diagnosis,” said Linda Geng, executive director of the Post-Acute Covid-19 Syndrome Clinic at Stanford.
In the absence of any objective tests, however, Covid has long remained a “diagnosis of exclusion”—one that is only made after other reasonable possibilities have been exhausted. Recent data suggests that many patients will emerge after this process with a diagnosis not of Covid, but of something else. A July newspaper in Nature that analyzed the medical records of more than 2 million patients in the UK showed that, while 5.4% of people with a previous Covid infection had at least one persistent Covid symptom recorded in their graph, 4.5% do not have Evidence of infection also has at least one symptom.
