A clinical case of viral-bacterial pneumonia caused by SARS-COV-2 and Klebsiella pneumoniae, complicated by a generalized infection with developed septicemia

Patient A.I., 58 years old, on September 6, 2022 was hospitalized within several hours in the infectious diseases department of the Novocheboksarskaya City Hospital of the Ministry of Health of Chuvashia. The patient in serious condition was admitted being accompanied by ambulance team, according to his son, from the night of 09/05/2022 until the afternoon of 09/06/2022 the patient complained of hectic temperature, diffuse pain in the abdominal cavity. In addition, the patient noted cough, feeling of air lack. As a result, an ambulance was called in. At admission, computed tomography revealed signs of bilateral viral interstitial pneumonia, with a lesion area of 51% and areas of consolidation. The diagnosis of COVID-19 was confirmed by PCR in a nasopharyngeal swab. History: Dyscirculatory encephalopathy of degrees 1–2, arterial hypertension, chronic indurative pancreatitis. Objective examination: on admission the body temperature was 38.8°C. SaO₂ — 56%. Blood pressure — 93/50 mm Hg. Art. Deep palpation revealed diffuse soreness and tension in the muscles of the anterior abdominal wall. The assessment of the condition on the NEWS2 scale comprised 11 points. Treatment was started, but a sudden death occurred. A clinical diagnosis was made: a new coronavirus infection COVID-19, virus verified. Competing disease: Acute parapancreatitis. Abscess of the mesentery of the small intestine. Complications of the underlying disease: Bilateral viral interstitial pneumonia. Acute respiratory distress syndrome. Septicemia (SOFA — 2 points, procalcitonin = 2 ng/ml). Post-mortem sectional examination revealed signs of viral-bacterial pneumonia. In the brain — pericellular and perivascular edema, heart — prominent edema of the interstitium, muscle fibers fragmented, kidneys — necronephrosis, pancreas — periductal, interlobular and intralobular sclerosis of the pancreas, between the islets of neutrophilic infiltrates. Hyperplasia was noted in the lymphoid and hematopoietic tissue, vasculitis, signs of interstitial inflammation in the parenchymal organs were determined. According to the results of microbiological examination of lung tissue, abundant growth of Klebsiella pneumoniae was found. Conclusion. The cause of death of the patient A.I. 58 years old was a novel coronavirus infection COVID-19, which caused bilateral viral pneumonia, in parallel with bacterial microflora, complicated by acute respiratory failure. There was also a generalized spread of infection with developed septicemia and multiple organ failure (pulmonary, cerebral, renal).