Complex case of COVID-19 and infective endocarditis
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Many publications have highlighted the importance of diagnosing and managing various cardiovascular complications from COVID-19 infection, including arrhythmias, acute coronary syndrome, myocarditis and deep venous thromboembolism (DVT). This case highlights the issue of IE and DVT in the setting of COVID-19 infection.

A focus of this case is highlighting the need to have a high clinical suspicion for alternative diagnoses when patients test positive for COVID-19. This includes sending a septic screen, blood culture, chest X-ray and urine culture in febrile patients.

A 50-year-old man with no medical history of note presented with new onset of confusion and dyspnoea. He tested positive for coronavirus (COVID-19), and subsequently, was admitted to the intensive care unit due to severe sepsis and acute renal failure requiring haemodialysis. Shortly afterwards, he was intubated due to haemodynamic instability. His blood culture was positive for Staphylococcus aureus bacteraemia, and echocardiogram showed evidence of vegetation in the aortic valve area.

He was commenced on intravenous antibiotics for infective endocarditis (IE). Following extubation, he underwent an MRI of the spine due to increasing back pain. This was suggestive of L5–S1 discitis, likely secondary to septic emboli from IE. A few days later, he developed acute ischaemia of the left toes and extensive thrombosis of the right cubital and left iliac veins. Following a prolonged hospital admission, he was discharged home and later underwent an elective forefoot amputation from which he made a good recovery.