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Case report
Haemophilus parainfluenzae endocarditis presenting with symptoms of COVID-19
  1. Laurie C Finch1,
  2. Spiro Gerdzhikov2 and
  3. Robert Buttery3,4
  1. 1Critical Care Centre, North West Anglia NHS Foundation Trust, Huntingdon, UK
  2. 2Department of Anaesthesia, North West Anglia NHS Foundation Trust, Huntingdon, UK
  3. 3Department of Respiratory Medicine, North West Anglia NHS Foundation Trust, Huntingdon, UK
  4. 4Department of Respiratory Medicine, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Laurie C Finch; laurie.finch1{at}nhs.net

Abstract

A young man presented early in the UK’s second COVID-19 pandemic surge with a twelve-day history of fever, dry cough, breathlessness, myalgia and loss of smell and taste. His chest X-ray showed bilateral ground-glass opacities. He was treated for COVID-19 pneumonitis but covered for bacterial infection with antibiotics. He developed shock and respiratory failure, requiring vasopressors and continuous positive airway pressure. He improved but experienced transient visual disturbances and headache. Nasopharyngeal swabs and antibody tests for COVID-19 were negative. Blood cultures grew Haemophilus parainfluenzae. A new murmur prompted an echocardiogram. This confirmed a large, mobile mitral valve vegetation. An MRI of the brain showed bilateral embolic infarcts. He underwent urgent mitral valve repair and made an excellent recovery. Whether COVID-19 caused his presenting symptoms or facilitated the bacteraemia remains unclear. It seems more likely that infective endocarditis masqueraded as COVID-19. Clinicians should be aware of how context of the pandemic can bias diagnostic reasoning.

  • COVID-19
  • infectious diseases
  • adult intensive care
  • valvar diseases
  • cardiothoracic surgery

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-245210

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    Footnotes

    • Contributors LCF drove the conception of the work, gathered the clinical details and images, drafted the report and revised the manuscript. SG provided critical review and reviewed the final manuscript. RB provided critical review, advised on the use of figures, edited the final manuscript and reviewed revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.