Skill Checkup: A 70-Year-Old Man With Loss of Smell, Dry Cough, and Headache

Enrico Brunetti, MD


November 07, 2022

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.


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