Septic embolism in a patient with infective endocarditis and COVID-19: a case report and review of management

Background: The diagnosis and treatment of infective endocarditis (IE) is facing great challenges during the coronavirus disease (COVID-19) pandemic, especially in patients without valvular heart disease. Methods: The 39-year-old patient with no pertinent medical history presented with high fever for 14 days and positive nucleic acid test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for 3 hours. He denied any trauma or IV drug use. Blood culture grew MRSA. CT revealed infectious metastases in spleen, liver, kidney and brain. Transesophageal echocardiography (TEE) was performed under safety protection finding mitral valve vegetation. His senses of smell, taste, hearing and vision were weakened temporarily. The patient was treated with daptomycin in combination with fosfomycin sodium and linezolid successively. On hospital day 10, the patient was transferred to ICU due to respiratory distress and cardiac insufficiency for 5 days with high flow oxygen noninvasive ventilation. After treatment, the patient achieved remission and was discharged from hospital. Results: We encountered a typical case of IE with multiple organ infection caused by MRSA sepsis combined with COVID-19, for which combination therapy was effective. Conclusions: Obvious risk factors of IE may be absent in many cases. A high index of suspicion is required, especially with additional findings such as embolic phenomenon, focal neurologic deficit, decompensated heart failure, or new murmurs. The purpose of this case report is to help clinicians by improving awareness of IE, particularly in patients having high suspicion despite any risk factors, during COVID-19 pandemic.