Abstract

Background: Viral respiratory diseases can present with ageusia (hypogeusia) and anosmia (hyposmia) due to viral neurotropism, usually manifest together with other symptoms in the acute phase and have in most instances both a good and short recovery. During the epidemic period of COVID-19, doctors should consider SARS-CoV-2 infection as a differential diagnosis. Recent series reporting these neurologic manifestations do not provide information about neither the timeline, nor the outcome of these symptoms in this scenario.

Patient’s concerns: A 54-year-old female physician with well-controlled diabetes, hypertension and arrhythmia who presented with an acute respiratory syndrome with influenza symptoms, with sudden onset of fever, followed by dry cough on the second day, and on the 4th day the patient noticed a sudden and total loss of smell and taste sensations. After 20 days, she noticed a mild return of flavor perception, mainly for spicy foods, but still complained of hyposmia and dysgeusia until the end of this report (30 days after the onset of neuropathic symptoms).

Diagnoses: COVID 19 associated with anosmia and ageusia induced by viral respiratory disease inflammation.

Intervention: cyanocobalamin supplementation to 9,000 micrograms per day.

Outcomes: A mild return of flavor began after the 20th day for specific seasoned foods, but olfaction didn’t improve. After 30 days of symptoms she performed a Sniffin Sticks Test, whose result was compatible with hyposmia. A longer follow-up should be warranted to better assess the final outcome.

Lessons learned: Anosmia and ageusia have been described as either an isolated manifestation or together within the clinical spectrum of SARS-CoV-2 (COVID-19). However, the definitive prognosis is still unclear - although she had total improvement of the COVID-19 respiratory manifestations, sensory symptoms remained. We present the timeline and the outcome of the sensory symptoms over 30 days.

Keywords: Olfaction disorders; Anosmia; Taste disorders; Ageusia; SARS-CoV-2 infection; Coronavirus; COVID-19

Abbreviations: ABR: Brazilian Academy of Rhinology; ABORL-CCF: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery; ACE: Angiotensin-Converting Enzyme; BID: two times a day; COVID-19: Coronavirus disease 2019; CT: Computed tomography; MERS: Middle East Respiratory Syndrome; RNA: ribonucleic acid; SARS: Severe acute respiratory syndrome; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; SpO2: Peripheral oxygen saturation; WHO: World Health Organization