CRYPTIC PREGNANCY, SYPHILIS AND CONSTITUTIONAL SYMPTOMS IN AN IV DRUG USER DURING THE COVID-19 OUTBREAK

ABSTRACT

Background Infective endocarditis (IE) during pregnancy is rare and is associated with high maternal and fetal morbidity and mortality. We report the case of a 30-year-old patient with IE who was incidentally found to be 24 weeks pregnant during the COVID outbreak. We also reviewed the relevant literature. Case An active intravenous drug user presented with a 2-week history of constitutional symptoms (myalgias, fever) and lower back pain during the COVID outbreak. Initial investigations revealed bilateral consolidations on chest X-ray. After she tested negative for COVID-19, CT chest showed septic pulmonary emboli and grew MSSA on blood cultures. An echocardiogram revealed a large (1.6 × 1.0 cm) mass attached to the tricuspid valve suggestive of IE with severe tricuspid regurgitation. She was also incidentally found to be 24 weeks pregnant (G1P0) and positive for syphilis. Viable intrauterine pregnancy was confirmed at 25 weeks on an ultrasound. She was treated with 5-weeks course of IV flucloxacillin, however a repeat echocardiogram demonstrated an increase in vegetation size (> 3 cm). As her vegetation size had increased, a surgical opinion for IE was sought. Cardiac operation under cardiopulmonary bypass in a pregnant woman is associated with high maternal and fetal morbidity and mortality. She was managed conservatively with oral antibiotics, regular echocardiographic and obstetrics reviews and delivered a healthy baby at 37 weeks following induction of labour. Conclusions: The review of literature confirms that if IE in pregnancy is diagnosed early, an uncomplicated outcome is possible with a multidisciplinary team approach.