Abstract We127: Infective Endocarditis in COVID-19 - An Unusual Suspect

Abstract

Introduction: The COVID-19 pandemic globally overwhelmed healthcare systems and the complications associated with this illness have contributed to poor outcomes. The hypercoagulable state associated with COVID-19 is well recognized in the literature. Thromboembolic complications such as left ventricular thrombus (LVT), deep venous thrombosis (DVT) and pulmonary embolism (PE) have been increasingly reported. Dhakal et al. published an association between COVID-19 and cardiovascular disease, including possible complication by infective endocarditis (IE) which was confirmed by Amir et al. reporting the first case. Since then, there have been few reported cases. We present a case of COVID-19 in a patient who developed LVT, complicated by non-valvular IE by an underreported organism, Granulicatella adiacens. Case Presentation: A 55-year-old male with history of dental caries, provoked DVT/PE, NSTEMI x2 and STEMI in-stent restenosis requiring thrombectomy presented to the hospital with a 2-day history of shortness of breath, fatigue, cough, change in mentation and right-sided weakness. He tested positive for COVID-19 by NAAT. CXR revealed cardiomegaly and multiple bilateral infiltrates. CT head demonstrated acute ischemic stroke of the left occipital, parietal and posterior temporal lobes, also confirmed on MRI. CTA neck showed 30% stenosis of left ICA. Blood cultures x2 resulted positive for G. adiacens. Echocardiogram was obtained, demonstrating reduced EF of 35% and the presence of a large, 2.7 x 2.2cm mobile thrombus in the apical-septal region of the left ventricle, not visualized on previous echocardiogram 6 months earlier. Methods: Data was collected from direct patient care and electronic medical records. Discussion: G. adiacens is a fastidious gram-positive coccus, part of the nutritionally variant streptococci (NVS) species, and part of the normal oral and gastrointestinal flora. It is also found in dental plaques and endodontic abscesses. NVS account for less than 5% of cases of bacteremia and IE. G. adiacens account for even fewer cases. Two separate meta-analyses conducted by Quintero-Martinez et al. and George et al. failed to reveal any cases of IE attributable to G. adiacens in the setting of COVID-19 infection. In conclusion, we believe that the hypercoagulable state of COVID-19 infection led to endocardial damage and development of LVT, thereby creating a nidus for microorganism adherence from underlying dental carries resulting in thromboembolic stroke.