Hypogeusia as the initial presenting symptom of COVID-19

Abstract

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. We present a case of COVID-19 resulting in intensive care unit (ICU) admission, presenting with the initial symptom of disrupted taste and flavour perception prior to respiratory involvement. After 4 days in the ICU and 6 days on the general medicine floor, our patient regained a majority of her sense of smell and was discharged with only lingering dysgeusia. In this paper, we review existing literature and the clinical course of SARS-CoV-2 in relation to the reported symptoms of hyposmia, hypogeusia and dysgeusia.

Keywords: adult intensive care; ear, nose and throat/otolaryngology; infectious diseases; mouth; pneumonia (respiratory medicine).

Figure 1

Chest radiograph, AP, day of admission. AP, anterior–posterior; R, right.

Figure 2

Chest CT, axial (A) and coronal (B), day of admission.

Figure 3

Timeline of our patient’s clinical course with COVID-19. CPAP, continuous positive airway pressure; ICU, intensive care unit; NAAT, nucleic acid amplification test.