Mark, a 29-year-old electrician presents to his GP with six episodes of cough, wheeze, yellow sputum and abdominal bloating over the past four months. He has had asthma since the age of eight, which has previously been controlled well with inhaled budesonide/formoterol 200/6 bd. He has no other known medical comorbidities and does not drink alcohol or smoke.

At initial presentation the clinical findings are consistent with an infective exacerbation of asthma, so Mark is prescribed antibiotics, a three-day course of prednisolone 50mg and an increased dose of budesonide/formoterol 400/12 bd.

Two weeks later, after resolution of his symptoms, Mark has a seventh episode, also associated with his usual cough, yellow sputum and abdominal pain. This time, however, he also has some diarrhoea and has tested positive for COVID-19 via PCR. For this, he is prescribed molnupiravir 800mg bd, and in view of his recurrent chronic moderate-to-severe asthma, is given a five-day course of Augmentin Duo Forte 875mg bd and prednisolone 50mg.

Another two weeks later, Mark’s typical symptoms of infectious exacerbation of asthma have resolved. However, he has developed foul-smelling diarrhoea with blood and mucus. He has new oral aphthous ulcers, as well as ongoing abdominal pain and bloating. He notes that when he was taking the prednisolone, his gastrointestinal symptoms had been significantly better.