Bacterial endocarditis following COVID-19 infection: two case reports

Abstract

Background: COVID-19, an emerging disease raised as a pandemic, urgently needed treatment choices. Some options have been confirmed as lifesaving treatments, but long-term complications must be clearly illustrated. Bacterial endocarditis is a less frequent disease among patients infected with SARS_COV_2 compared to other cardiac comorbidities in these patients. This case report discusses bacterial endocarditis as a potential adverse effect after administering tocilizumab, corticosteroids, and COVID-19 infection.

Case presentation: In the first case, a 51-year-old Iranian female housewife was admitted to the hospital with fever, weakness, and monoarthritis symptoms. The second case is a 63-year-old Iranian woman who is a housewife admitted with weakness, shortness of breath, and extreme sweating. Both cases tested positive for Polymerase chain reaction (PCR) less than one month ago and were treated with tocilizumab and corticosteroid. Both patients were suspected of infective endocarditis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the blood cultures of both patients. The diagnosis of endocarditis is confirmed for both cases. Cases are subjected to open-heart surgery, a mechanical valve is placed, and they are treated with medication. In subsequent visits, their condition was reported to be improving.

Conclusion: Adjacent to cardiovascular inclusion as COVID-19 disease complications, secondary infection taken after the organisation of immunocompromising specialists can result in basic maladies and conditions counting infective endocarditis.

Keywords: COVID-19; Infective endocarditis; Secondary infection; Tocilizumab.

Fig. 1

Highly mobile echogenicity on the anterior and septal leaflet tricuspid valve replacement with protruding to right ventricle cavity in favour of vegetation

Fig. 2

There are several nodules in both lower lobes; two cavitated nodule is also seen in the right lower lobe; one of them is subpleural with a feeding vessel sign

Fig. 3

There are several nodules in both lower lobes; two cavitated nodule is also seen in the right lower lobe; one of them is subpleural with a feeding vessel sign

Fig. 4

Shaggy appearance echogenicity with multiple highly mobile particles in favour vegetation on the posterior mitral leaflet

Fig. 5

There are multiple patchy consolidations and ground-glass opacities in both lower lobes with peribronchial thickening)