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Purpose: The coronavirus disease 2019 (COVID-19) is surrounded the world and is associated with multiorgan damage. Olfactory dysfunction is a common manifestation in COVID-19 patients, and in some cases, presents before the coryza signs. We conducted this umbrella review to provide a practical guide on managing, imaging findings, and follow-up of COVID-19 patients with olfactory dysfunction (OD). Methods: A comprehensive search was performed in PubMed, Embase, Scopus, and Web of Science databases from December 2019 until the end of July 2022. Systematic reviews and meta-analyses addressing management and imaging findings of the olfactory manifestations of COVID-19 were included in the study. The quality assessment of included articles was carried out using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. Results: A total of 23 systematic reviews were reviewed in this umbrella review. The number of included studies varied between 2 to 155 articles. Several demographic variables were not adequately reported across all the included systematic reviews, including age, gender, preexisting comorbidities, or whether participants had been hospitalized or admitted to the intensive care unit (ICU) due to COVID‐19. Conclusion: It seems that the coronavirus can infect olfactory system structures that play roles in the transmission and interpretation of smell sense. Based on studies, a large proportion of patients experienced OD following COVID-19 infection, and the majority of OD was resolved spontaneously. The possibility of long-lasting OD was higher in young adults with moderate clinical manifestation. Olfactory training (OT) was the most effective therapy. Intranasal corticosteroids (ICS) are also recommended.

The role of the gut microbiome in influencing immune function and homeostasis is being investigated. A 56-years-old female patient was referred due to nightmares, insomnia, pain, and redness in all her fingers. At first, Zolpidem was prescribed by a psychiatrist, but it induced a stuffy nose, change in behavior, drugged feeling, and tiredness. Previously she had been referred to a rheumatologist, and after some visits, atypical scleroderma had been diagnosed. She received psychiatric treatment with quetiapine and melatonin and was prescribed a probiotic diet. The patient was followed up and showed an excellent therapeutic response after augmentation with diet therapy. The treatment based on gut or fecal microbiome transplantation (FMT) may affect the patient's behavior and sleep disturbance. Thus the key point is the role of gut microbiota and FMT-based therapy in chronic rheumatic patients with resistance and refractory psychiatric symptoms, which improves the quality of life and acceptance of treatment.