Diagnosis of COVID-19 in a geriatric patient hospitalised for fall with initial misinterpreted aspiration pneumonia

Abstract

BACKGROUND SARS-CoV-2 is a virus which is more aggressive in aged patients with associated chronic age-related diseases. Although it is known that clinical picture of COVID-19 is already multifaceted, very little is still known about the infectious syndrome in aged patients. We present a case of an aged patient hospitalized for fall affected from Covid19 pneumonia, initially misinterpreted for an aspiration pneumonia. CASE PRESENTATION We describe the case of a 92 years patient with chronic heart diseases, hospitalized for fall complicated by head trauma. She was diagnosed with an aspiration pneumonia due to the fall so that she was put under antibiotics treatment. Despite four days of antibiotics treatment, the patient presented high fever and dry cough motivating in an epidemic period the nasopharyngeal PCR test for the research of SARS-CoV-2 which resulted positive. DISCUSSION AND CONCLUSION Aspiration pneumonia resulting from a fall is a common finding in geriatric patients, that’s why the diagnosis of COVID-19 was delayed. The geriatric population often have an altered clinical presentation of diseases, in particular regarding infectious diseases. The correct interpretation of some suspicious findings such as regular blood tests would have led more quickly to a diagnosis of non-aspiration pneumonia. Inflammatory markers and white blood cell count resulted within the normal range. Moreover, lymphopenia, considered as one of the biological features of COVID-19, was the only tract that appeared once the patient started to have symptoms. The presence of confusion as a sign of persisting infection in an older patient should not be underestimated, expression of a possible involvement of nervous system in SARS-CoV-2 infection. The common diagnosis of aspiration pneumonia in the geriatric field, the aspecific signs and symptoms of COVID-19 disease, the complex picture of our patient, prove that in geriatrics an apparently simple diagnosis could instead be insidious and complex.