A Case of Triple Respiratory Coinfection: COVID-19, Enterovirus, and Parainfluenza

We report a case of a 34-year-old female who presented to the emergency department with fever, nausea, vomiting, and diarrhea following a suspected foodborne illness. She tested positive for COVID-19, human parainfluenza virus type 4, and enterovirus/rhinovirus in the hospital. She subsequently developed hypoxia, hypotension, and sepsis. Blood work revealed leukocytosis and elevated inflammatory markers. Imaging of her abdomen showed fluid-filled bowel loops suggesting acute gastroenteritis and colitis of infectious or inflammatory etiology. She was initially treated with antibiotics for a suspected bacterial infection. However, her cultures resulted negative and her symptoms slowly improved with supportive care including probiotics and a low-fat diet. Due to her persistent shortness of breath related to her COVID-19 infection, she was started on a course of oral prednisone due to the anti-inflammatory effects of steroids. She was discharged home in stable condition with close outpatient follow-up. This study highlights the clinical challenges of managing multiple viral infections, particularly with concurrent COVID-19.