Blood-tinged Phlegm and Nasal Discharge After COVID-19

Hemoptysis and epistaxis?

Hello Doctor, I am currently 23 years old, do not smoke, and have no history of asthma (although I had acute bronchitis several years ago).
Since being diagnosed with COVID-19 early last year, I have frequently felt a buildup of thick phlegm in my chest that I cannot expel, along with chest tightness and difficulty breathing.
Earlier this year, I began to cough up frothy sputum, and I can feel the mucus moving between my lungs and throat, producing a wheezing sound when I talk or breathe.
The clinic doctor mentioned that my symptoms resemble asthma.
In February, I had blood tests and X-rays at the hospital, which showed no abnormalities, but I was diagnosed with a Mycoplasma pneumonia infection.
The doctor assessed that adults with Mycoplasma infections can recover on their own and prescribed me a bronchodilator and nasal decongestant.
However, I have started to cough up thick white sputum with blood streaks and have noticed blood in my nasal discharge, along with a vague bruised pain in my chest.
I would like to ask if Mycoplasma can cause hemoptysis? Additionally, the hemoptysis has persisted for about a week; should I return for a follow-up?

AA, 20~29 year old female. Ask Date: 2024/02/18

Dr. Shen Bochan reply Pulmonology

Hello, it is recommended to seek medical attention at our hospital to clarify your condition.
Indeed, most mycoplasma infections can resolve on their own without medication due to the immune response; however, if it progresses to pneumonia, specific pharmacological treatment is necessary.
This is especially true after a COVID-19 infection, as the body's resistance to these pathogens seems to be weakened.
This information is provided for your reference.

Reply Date: 2024/02/18

More Info

It sounds like you are experiencing a range of concerning symptoms following your COVID-19 infection, particularly the presence of blood-tinged phlegm and nasal discharge. Let's break down your situation and address your questions based on medical knowledge.

Firstly, the presence of blood in phlegm, known as hemoptysis, can be alarming. In your case, since you have a history of COVID-19 and subsequent respiratory symptoms, it's important to consider several factors. Blood-tinged phlegm can arise from various sources in the respiratory tract, including the lungs, bronchi, or even the nasal passages. Given your description of thick, sticky phlegm and the sound of wheezing during breathing, it is possible that your airways are inflamed or irritated, which can lead to bleeding.

Regarding your question about whether mycoplasma pneumonia can cause blood-tinged phlegm, the answer is yes, although it is less common. Mycoplasma pneumonia is known to cause atypical pneumonia, which can lead to symptoms such as a persistent cough, chest discomfort, and sometimes hemoptysis. The inflammation caused by the infection can irritate the airways and lead to small blood vessels breaking, resulting in blood appearing in your phlegm. However, it is crucial to rule out other potential causes of hemoptysis, such as bronchitis, pneumonia, or even more serious conditions like pulmonary embolism or lung cancer, especially since you have a history of respiratory issues.

Given that your symptoms have persisted for about a week and you are experiencing chest pain that feels like bruising, it is advisable to return to your healthcare provider for further evaluation. A follow-up visit is warranted to assess the severity of your symptoms and to determine if additional diagnostic tests, such as a CT scan of the chest or further blood tests, are necessary. This is particularly important if you notice an increase in the volume of blood in your phlegm or if your symptoms worsen.

In addition to the respiratory symptoms, you mentioned experiencing a sensation of chest tightness and difficulty breathing. These symptoms can be indicative of bronchospasm or airway obstruction, which may require the use of bronchodilators or other medications to help alleviate your symptoms. It is also essential to monitor your oxygen saturation levels, as any significant drop could indicate a need for immediate medical attention.

Lastly, regarding your concern about the potential long-term effects of COVID-19, it is increasingly recognized that some individuals may experience lingering respiratory symptoms, often referred to as "long COVID." This can include chronic cough, difficulty breathing, and the production of phlegm. If your symptoms are related to long COVID, a multidisciplinary approach involving pulmonologists, physical therapists, and possibly mental health support may be beneficial.

In summary, while mycoplasma pneumonia can cause blood-tinged phlegm, it is crucial to seek further medical evaluation to rule out other potential causes and to address your ongoing symptoms. Please do not hesitate to reach out to your healthcare provider for a thorough assessment and appropriate management of your condition.

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