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

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 COVID-19 pneumonia, initially misinterpreted for an aspiration pneu-monia. Case presentation. We describe the case of a 92 years patient with chronic heart diseases, hospitalized for fall complicated by head trau-ma. 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 conclusions. 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 biological1. The presence of confusion as a sign of persisting infection in an older patient should not be under-estimated, expression of a possible involvement of nervous system in SARS-CoV-2 infection2. 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. Copyright © by Societa Italiana di Gerontologia e Geriatria (SIGG).