This case report describes an 85-year-old woman with a history of aspiration pneumonia who was admitted to a rural hospital with fever, vomiting, and decreased oxygenation. Initially diagnosed with aspiration pneumonia and acute pyelonephritis, she was treated with antibiotics. Despite this, her fever persisted, and subsequent imaging suggested aspiration pneumonitis or organizing pneumonia. Her condition improved following fasting and corticosteroid therapy. This case highlights the challenges in differentiating aspiration pneumonia from aspiration pneumonitis, as both conditions may present similarly but require different treatment approaches. Persistent fever despite broad-spectrum antibiotics prompted a change in treatment strategy, leading to the introduction of corticosteroids, which improved her symptoms. This case underscores the importance of considering aspiration pneumonitis in older patients with recurrent or persistent respiratory symptoms and fever, especially when dysphagia is present and antibiotic therapy is ineffective. Early intervention with corticosteroids, particularly when imaging findings are suggestive of organizing pneumonia, can prevent further deterioration. Accurate diagnosis and timely treatment adjustments are crucial in managing aspiration-related pulmonary conditions in elderly patients.
