COVID-19 and Cavitary Lesion in Lung

Abstract

The clinical manifestations of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are widespread, ranging from asymptomatic to critical illness with significant morbidity and mortality. It is widely known that individuals who have viral respiratory infections are more likely to develop bacterial infections. Throughout the pandemic, despite the fact that COVID-19 was thought to be the primary cause of millions of deaths, bacterial coinfections, superinfections, and other secondary complications played a significant role in the increased mortality rate. In our case, a 76-year-old male presented to the hospital complaining of shortness of air. Polymerase chain reaction (PCR) testing was positive for COVID-19 and cavitary lesions were discovered on imaging. Treatment was guided based on the results of bronchoscopy with bronchoalveolar lavage (BAL) cultures showing methicillin-resistant Staphylococcus aureus (MRSA) and Mycobacterium gordonae. However, the case was later complicated by the development of a pulmonary embolism after anticoagulants were held due to new onset hemoptysis. Our case highlights the importance of considering bacterial coinfection in cavitary lung lesions, appropriate antimicrobial stewardship, and close follow-up for full recovery in COVID-19 infections.

From Emergence to Endemicity: A Comprehensive Review of COVID-19

“…Pulmonary embolism (PE), pneumothorax, ARDS, and pneumonia are the well-known reported presentations during acute infection [ 103 , 112 ]. Sporadic case of the secondary bacterial process along with COVID-19 infection causing cavitary lung lesion [ 113 ] has been reported. Pneumothorax due to barotrauma from ventilation, as well as spontaneous pneumothorax due to damage to the alveolar wall, has been reported with a median duration of nine days since the start of symptoms, with a mortality rate of 36% [ 103 , 114 ].…”

COVID-19-Related Left-Sided Ptosis

“…Another well-researched complication is thrombosis, where 27% incidence of venous and 3.7% arterial thrombosis; splenic infarctions being rare among them were identified [ 2 ]. Occasionally, COVID-19 also presents with lung cavitation due to secondary bacterial infections [ 3 ]. Invasive pulmonary aspergillosis has also been reported after treatment of COVID-19 [ 4 ].…”

“…Higher morbidity and mortality rates are seen in co-infection with bacterial and viral organisms [ 3 ]. Benign neurological symptoms, like headaches and anosmia, are commonly reported with COVID-19 [ 5 , 6 ].…”

COVID-19: From Emergence to Endemicity - A Comprehensive Review

“…Pulmonary Manifestations: Pulmonary embolism, pneumothorax, ARDS (acute respiratory distress syndrome), and pneumonia are the well-known reported presentations during acute infection (103,112). Sporadic case of the secondary bacterial process along with COVID-19 infection causing cavitary lung lesion (113) has been reported. Pneumothorax due to barotrauma from ventilation as well as spontaneous pneumothorax due to damage to the alveolar wall has been reported with a median duration of nine days since the start of symptoms, with a mortality rate of 36% (103,114).…”