Sars-Cov-19 associated with aspiration pneumonia in a patient with Parkinson disease: A case report

Abstract

Coronaviruses can cause multiple systemic infections respiratory complications are the most recognizable symptoms similar to severe acute respiratory syndrome coronavirus (SARS-CoV). Aspiration pneumonia was the most common reason for the Emergency admission of patients with PD.Here we report the case a patient with Parkinson's disease admitted for respiratory insufficiency secondary to Covid-19 and aspiration pneumonia. A 78-years- old male patient, treated for Parkinson's disease, was admitted to the emergency department with symptoms of acute respiratory insufficiency. Four days before his admission, the patient suffered from solid dysphagia. On physical examination, the patient was obnibulated, febrile at 39 °, with clinical signs of respiratory insuffisiency. Computed tomography of the neck and Chest showed patchy areas of subpleural ground glass opacities with vascular dilatation associated with bilateral posterobasal and anterior consolidations with air overlapping imaging characteristics of aspiration and covid 19 pneumonia. The CT scan also showed an oesophageal hypodensity consistant with endoluminal foreign body. Reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 was positive.The diagnosis of Sars-cov 19 associated with aspiration pneumonia were retained. An esophagoscopy was realized, a foreign body visualized in the upper sphincter of the esophagus and an impacted food bolus was retracted. We would like to emphasize the challenging differential diagnosis of pneumonia caused by aspiration of different materials and Sars-cov 19. Definite discrimination of the two diagnoses might be impossible. Some radiologic features may suggest one diagnos over the other. While lobar or segmental pneumonia, lung abscess, and empyema have been reported as Complications of aspirations pneumonia these outcomes are rarely Considered Complications of COVID-19 pneumonia. Centrilobular nodules and tree-in-bud sign are commonly seen in cases with aspiration. Interestingly, these CT findings are not frequent in COVID-19 pneumonia and have been categorized as "Atypical" by the Radiological Society of North America (RSNA), and therefore could be of some Value in proposing a differential diagnosis. Bilateral subpleural patches of ground-glass opacity (GGO), especially in basal distribution, have been described as typical for the diagnosis of COVID-19 pneumonia in suspected Cases. Such a presentation is also fairly common in aspiration Pneumonia.

Keywords: Aspiration pneumonia; Coronavirus; Dyspnea; Foreign body ingestion; Parkinson's disease; Sars-Cov-19.

Fig. 1

Computed tomography of the neck and Chest, axial slices: patchy areas of subpleural ground glass opacities with vascular dilatation associated with bilateral anterior and posterobasal, consolidations with air bronchogram, Featuring overlapping imaging characteristics of aspiration and covid 19 pneumonia.

Fig. 2

Computed tomography of the neck and Chest: oesophageal endoluminal foreign body.

Fig. 3

Picture of the foreign body retracted from the oesophagus: impacted food bolus.