Severe bacterial complications of COVID-19 pneumonia treated with corticosteroids: description of two cases

ABSTRACT

Background: SARS-CoV-2 infection, in the most severe cases, can cause bilateral pneumonia and respiratory failure. In these cases, therapy is based on the use of antiviral drugs, immunosuppressants (in order to reduce the cytokine-mediated inflammatory response),oxygen and sometimes non-invasive mechanical ventilation (NIV).We describe 2 cases of severe bacterial infections probably favored by the immunosuppressive therapy. Description of the cases A 63-year-old man with no history of significant medical conditions and an 86-year-old man with history of ischemic heart disease treated with PTCA+DES, were both hospitalized for severe bilateral SARS-CoV-2 pneumonia and treated with NIV associated with high-dose steroids (Dexamethasone 8 mg IV per day). After the resolution of the pulmonary infection, the first one developed a Pneumocystis jirovecii pneumonia with the need for re-hospitalization and treatment with trimethoprim-sulfamethoxazole;the second one developed a methicillin-resistant Staphylococcus aureus (MRSA) endocarditis with infarct lesions caused by septic emboli in brain and splenic area, with subsequent clinical aggravation and death. Conclusions: The SARS-CoV-2 pneumonia treatment is based on combined use of NIV and anti-inflammatory, antiviral and immunosuppresive drugs it is important to minimize duration of treatment because it may lead to the development of serious complications like septic states (even by opportunistic pathogens) that are lifethreatening for the patients.