Case presentation
This patient, a 66-year-old man, developed a severe dysphagia of not immediate diagnosis during hospitalization for Covid-19. He suffered from diabetes mellitus for about 10 years and chronic obstructive pulmonary disease (COPD). His drug therapy only consisted of metformin. He has never been hospitalized before. He accessed the Emergency Room on 9th March 2020 due to persistent fever for several weeks and worsening dyspnea. Nasopharyngeal swab for the detection of Sars-CoV-2 was positive. Chest computed tomography (CT) scan showed extensive inflammatory areas with ground-glass opacities. Due to worsening respiratory pattern, the patient was placed on Continuous Positive Airway Pressure (CPAP) and started therapy with antibiotics, antivirals and hydroxychloroquine. In the following days, despite the use of CPAP, the clinical picture worsened up to ARDS and required tracheal intubation (on 12th March). On 24th March tracheotomy tube was placed. In the following weeks there was a slow but progressive improvement in respiratory exchanges that allowed a gradual weaning from the ventilator. At the end of April, a neurological evaluation was required due to loss of strength affecting the left lower limb. Brain CT showed no acute lesions. Because of abundant secretions in the airways, tracheal tube was not removed. Initial assessment of swallowing (nursing screening with Evan’s Blue dye test) performed at the beginning of May did not detect signs or symptoms of dysphagia, so parenteral nutrition was stopped and the patient started eating with modified diet and thickened liquids (honey-thick and spoon-thick). The texture of food was gradually modified from pureed diet to solid food. At the beginning of May nasopharyngeal swabs for detecting Sars-CoV-2 were negative and on 22th May the patient moved from the acute care hospital to the Rehabilitation Unit.