ABSTRACT
Objective: To understand that loss of sternutation may be a sequelae of COVID-19 infection. Background: While chemosensory dysfunction has been described with COVID-19 (Moein, 2020), its effects on sternutation have not heretofore been reported. Case Study: A 50 year old right-handed woman was nasute until four months prior to presentation;when she developed a temperature of 102.4°F, nasal congestion, myalgia, rigors and a total loss of smell and taste. Two days later, nasopharyngeal swab for SARS-CoV-2 RNA was positive. Over the next two months, her smell and taste had returned to normal. While prior to the infection, she would sneeze once or twice every day;since having COVID-19, she no longer sneezes. Results: Abnormalities in Neurological Examination: Reflexes: 3+ quadriceps femoris bilaterally and pendular. Bilateral Hoffman reflexes: present. Chemosensory Testing: Brief Smell Identification Test: 10 (normosmia). Retronasal Olfactory Testing: Retronasal Smell Index: 7 (normal). Gustatory Testing: Propylthiouracil Disc Taste Test: 9 (normogeusia). Sensonics Waterless Empirical Taste Test: 53 (normogeusia) Other: Fiberoptic Endoscopy: normal. CT Scan of Sinuses: Right maxillary sinusitis. Conclusions: Coronavirus may have impacted cranial nerve I which may function along with cranial nerve V to precipitate the sternutation reflex. The efferent component of the sternutation center of the pons which generates the sneeze reflex may have been impacted by the coronavirus, peradventure through a lesion of the pontomedullary sneeze center, adjacent to the descending trigeminal nucleus and tract (Hersch, 2000). Alternatively, this may represent dysfunction of pontine trigeminal reticular neurons and the pneumotaxic center (Batsel, 1975). Persistent absence of sternutation may have potential health effects for the sufferer in that it may allow irritants, potential toxins, or pathogens to invade the nasal mucosa, and thus enhance the likelihood of disease. Further investigation into those having COVID-19 for elimination of sternutation reflex is warranted.