Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Coronavirus disease 2019 (COVID-19) is a novel coronavirus that caused respiratory tract infection of unknown sources on December 31, 2019, in Wuhan, Hubei, China. COVID-19 can range from asymptomatic to severe [ 1 ]. Its most common symptoms are fever (98%), cough (76%), dyspnea (55%), myalgia, and fatigue (44%) [ 1 , 2 ]. In some COVID-19 patients, gastrointestinal involvement, acute cardiac, and acute kidney injuries are also reported. Moreover, some neurological symptoms, including dizziness, headache, hypogeusia, and hyposmia are found as well. Severe COVID-19 cases are accompanied by both ischemic stroke and intracerebral hemorrhagic stroke and loss of consciousness [ 3 , 4 ]. Cardiovascular disease is one of the most frequent comorbidities in COVID-19 patients which requires hospitalization, has a higher case fatality rate, and is more severe [ 5 ]. Endocarditis is a severe infectious disease with a high mortality rate [ 2 - 5 ]. Its in-hospital mortality rates are 12-17%, 23%-26%, 10%, and 8% for inherent valve, prosthetic valve, cardiac implantable electronic device, and right-sided endocarditis, respectively [ 6 ]. Fungal endocarditis in patients with prostatic valves can be a severe threat with high mortality and morbidity [ 7 ]. The immune dysregulation associated with COVID-19 contributes to microbial proliferation and the development of infection. There are few reports of COVID-19 cases with concomitant fungal endocarditis [ 7 , 8 ]. The clinical manifestations of infective endocarditis and COVID-19 overlap, including fever, dyspnea, fatigue, cough, and myalgia; hence, its differential diagnosis can be challenging. Therefore, the initial screening of COVID-19 concomitant with infective endocarditis is ambiguous. The present study presents a catastrophic case of fungal prosthetic valve endocarditis (PVE) and COVID-19 comorbidity. Every clinician, especially those in developing countries, should consider echocardiography when evaluating the COVID-19 patients with a prosthetic heart valve.