A 95-year-old Patient With Unexpected Coronavirus Disease 2019 Masked by Aspiration Pneumonia

A Case Report

Francesco Spannella; Letizia Ristori; Federico Giulietti; Serena Re; Paola Schiavi; Piero Giordano; Riccardo Sarzani


J Med Case Reports. 2020;14(82) 

In This Article


Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, has spread globally since the first cases were described in November 2019 in Wuhan, China. Since 21 February 2020, when COVID-19 emerged in northern Italy's Lombardy region, the number of infected patients in Italy closely followed an exponential trend, with the risk of reaching saturation point for beds in intensive care units. The higher risk of complications and death in older patients was immediately evident.[1] In a Chinese report, older patients accounted for 15.1% of the patients affected by COVID-19 and 27% of patients with severe disease were older than 65 years.[2] The Italian National Institute of Health (Istituto Superiore di Sanità; ISS) found that 38.4% of the patients affected by COVID-19 in Italy were older than 70 years of age. Moreover, the case fatality rate increases with increasing age, reaching 32.7% for those over 80 years of age.[3] Lung injury plays a central role in the pathophysiology and symptoms of COVID-19.[4]

Respiratory diseases and pneumonia per se are among the major causes of hospitalization in the older population with a marked higher mortality rate compared to the adult population.[5] Aspiration pneumonia is a leading cause of pneumonia in older patients, accounting for 5 to 15% of all cases of community-acquired pneumonia,[6] and it is estimated that at least 70% of hospitalized pneumonia in patients older than 70 years can be diagnosed as aspiration pneumonia.[7]

In this case report, we describe the clinical/imaging features of a case of COVID-19 pneumonia, initially defined as common aspiration pneumonia, and its diagnostic process in a very old patient with comorbidities, when the SARS-CoV-2 infection was not yet widespread in Italy.