ABSTRACT
The first cases of COVID-19 infection were reported as pneumonia of unknown cause in China in December 2019. While respiratory complications remain the hallmark of the disease, multisystem involvement has been well documented. Cardiovascular involvement with potentially lethal myocarditis has been extensively reported in the literature. Reports of conduction system disturbances are much rarer, especially in patients without other signs of cardiac involvement. We present a case of an 88-year-old male with no prior cardiac history who presented to the hospital with obstipation. He was diagnosed with a small bowel obstruction and underwent a lysis of adhesions. During the hospitalization, he developed intermittent bradycardia with a high-degree atrioventricular (AV) block. A decision was made to implant a permanent pacemaker. During a pre-procedure COVID-19 screen, he was found to be positive for the presence of SARS-CoV-2 RNA. He had no signs of myocardial injury, a transthoracic echocardiogram showed no abnormalities, and he remained free of any respiratory symptoms. While the involvement of the cardiac conduction system has been documented in patients with symptomatic COVID-19 infection, our patient only exhibited conduction abnormalities and remained free of other COVID-19 symptoms. The sole involvement of the conduction system by COVID-19 is rare, especially in patients with otherwise asymptomatic infections. There is no long-term data to suggest whether such conduction abnormalities are temporary or permanent. As such, patients might benefit from the implantation of a permanent pacemaker.
ABSTRACT
Pseudomonas mendocina is a Gram-negative bacillus from the family Pseudomonadaceae. The first P. mendocina-related infection was reported in 1992. Although a rare cause of infections, P. mendocina has been known to cause severe infections that require intensive treatment. We present the first documented case of urinary tract infection caused by P. mendocina. An 83-year-old male with a past medical history of diabetes, hypertension, coronary artery disease, and prostate cancer with bone metastases, currently being treated with abiraterone and prednisone, presented with subjective fever, fatigue, altered mental status, dysuria, and hematuria of one-week duration. He was found to have a complicated urinary tract infection with an incidental asymptomatic COVID-19 infection on admission. The patient was empirically treated with ceftriaxone and switched to cefepime for broader coverage on day two of hospitalization. Urine culture reported the presence of P. mendocina with resistance only to fluoroquinolones. Ceftriaxone was reinstated. The patient was successfully treated with a seven-day course of ceftriaxone (days 1-3, days 6-7) and cefepime (days 4-5) but continued to remain inpatient for a later symptomatic COVID-19 pneumonia with discharge on day 15. The majority of P. mendocina infections present as skin and soft tissue infections, infective endocarditis, meningitis, and bacteremia. Ours is the first documented case of urinary tract infection caused by P. mendocina, particularly in an immunocompromised COVID-19 patient, and the second to report P. mendocina with resistance to fluoroquinolones. This report contributes to the growing literature regarding P. mendocina-related infections.