Covid-19 And Infective Endocarditis - The Challenge of the 21st Century

Abstract

     COVID-19 can cause multiple organ dysfunction including cardiovascular system that affects the course and prognosis of disease. We present a case of a 65-year-old man with a history of arterial hypertension and severe COVID-19 complicated with acute pneumonia, acute respiratory distress syndrome, septic shock, infective endocarditis, severe stenosis and regurgitation of aortic valve, spontaneous pneumothorax and acute kidney failure.

    Chest CT scan included bilateral lung involvement with subtotal ground-glass opacities and consolidations. Lung injury was considered as H type. Echocardiography revealed hyperechogenic formation (5mm in size) - vegetation on the right coronary cusp of aortic valve, that caused sever stenosis and regurgitation. On the extremities Janeway lesions and Osler's nodes were revealed. He became hemodynamically unstable. Besides leukocytosis, neutrophilia with a left shift, lymphopenia, eosinopenia, moderate thrombocytopenia and deep anemia, high level of CRP, procalcitonin and severely increased D-Dimer (83600 µg/L) was notable.  In spite of adequate treatment with dexamethasone, antibiotics and anticoagulants patient developed first left sided and lately right sided complete spontaneous pneumothorax and was connected to mechanical ventilation. Though after thoracentesis and air evacuation from pleural cavities both lungs were expanded patient’s state remained critical. Patient developed septic shock, acute renal failure, acute cardiovascular and respiratory insufficiency and lethal outcome was defined.

     Presented case shows that COVID-19 causes different kind of multiple organ dysfunction that determines the outcome of the disease. It is important to follow and monitor the patients not only in critical and sever but in mild or common cases as well.