Skill Checkup: Man With Loss of Smell, Dry Cough, and Headache

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 70-year-old man in Europe first presented with body aches, headache, dry cough, and fever 1 year ago. His past medical history is significant for type 2 diabetes, which was well-managed with metformin therapy and dipeptidyl peptidase-4 inhibitors (saxagliptin). He also can control hypertension with an angiotensin-converting enzyme inhibitor (ACE) inhibitor (benazepril). He had not received a coronavirus disease 19 (COVID-19) vaccine, and his nasopharyngeal polymerase chain reaction (PCR) swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was given a monoclonal antibody (mAb) infusion. Symptoms quickly resolved, with only a lingering cough and fatigue.

Today, the patient presents again with an incessant dry cough and headache. He began to lose his sense of smell about 4 days ago. He remains unvaccinated for COVID-19. Diabetes and hypertension are still well-controlled. Nasopharyngeal PCR swab comes back positive for SARS-CoV-2. Body mass index is 30 kg/m². Temperature is 36.8°C (98.2°F), respiratory rate is 16 breaths per minute, oxygen saturation (SpO2) is 98% on room air, pulse rate is 74 beats per minute, and blood pressure is 139/82 mmHg. Heart sounds are normal, and bilateral vesicular breathing is heard on lung auscultation. No neurologic symptoms are noted.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Enrico Brunetti. Skill Checkup: A 70-Year-Old Man With Loss of Smell, Dry Cough, and Headache - Medscape - Nov 07, 2022.

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