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.