A Unique Presentation of Delirium in a Patient with Otherwise Asymptomatic COVID-19

Alkeridy W.A.,
Almaghlouth I.,
Alrashed R.,
Alayed K.,
Binkhamis K.,
Alsharidi A.,
Liu-Ambrose T.
Document Type
Source Title
Journal of the American Geriatrics Society
Blackwell Publishing Inc.


OBJECTIVE: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), manifests with a wide spectrum of presentations. Most reports of COVID-19 highlight fever and upper respiratory symptoms as the dominant initial presentations, consistent with the World Health Organization guidelines regarding suspected SARS-CoV-2 infection. However, atypical presentations of this disease have been evolving since the initial outbreak of the pandemic in December 2019. We report a case of an older male patient who presented at our hospital with an unusual manifestation of COVID-19. DESIGN: Brief report. SETTING: A university hospital in Saudi Arabia. PARTICIPANT: A 73-year-old man who presented with confusion in the absence of any respiratory symptoms or fever. INTERVENTION: The patient was initially admitted with delirium and underwent a further work-up. MEASUREMENTS: Given his recent history of domestic travel and the declaration of a global COVID-19 pandemic status, the patient was administered a swab test for SARS-CoV-2. RESULTS: The patient's positive test led to a diagnosis of COVID-19. Although he began to experience a spiking fever and mild upper respiratory symptoms, he recovered rapidly with no residual sequela. CONCLUSION: The recognition of atypical presentations of COVID-19 infection, such as delirium, is critical to the timely diagnosis, provision of appropriate care, and avoidance of outbreaks within healthcare facilities during this pandemic. J Am Geriatr Soc 68:1382-1384, 2020. © 2020 The American Geriatrics Society

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Index Keywords

hydroxychloroquine; piperacillin plus tazobactam; acute confusion; aged; Article; aspiration pneumonia; asymptomatic disease; blood culture; case report; clinical article; computer assisted tomography; coronavirus disease 2019; delirium; emergency ward; fever; hospital acquired pneumonia; hospital admission; hospitalization; human; infection control; male; medical history; nonhuman; pandemic; percutaneous coronary intervention; practice guideline; proprioception; real time polymerase chain reaction; reverse transcription polymerase chain reaction; Saudi Arabia; Severe acute respiratory syndrome coronavirus 2; thorax radiography; urine culture; asymptomatic infection; Betacoronavirus; Coronavirus infection; delirium; psychology; virology; virus pneumonia; Aged; Asymptomatic Infections; Betacoronavirus; Coronavirus Infections; Delirium; Humans; Male; Pandemics; Pneumonia, Viral