Background SARS‐CoV2 has affected more than 73.8 million individuals. While SARS‐CoV2 is considered a predominantly respiratory virus, we report a trend of bradycardia among hospitalized patients, particularly in association with mortality. Methodology The multi‐center retrospective analysis consisted of 1053 COVID‐19 positive patients from March to August 2020. A trend of bradycardia was noted in the study population. Absolute bradycardia and profound bradycardia was defined as a sustained heart rate < 60 BPM and < 50 BPM, respectively, on two separate occasions, a minimum of 4 h apart during hospitalization. Each bradycardic event was confirmed by two physicians and exclusion criteria included: less than 18 years old, end of life bradycardia, left AMA, or taking AV Nodal blockers. Data was fetched using a SQL program through the EMR and data was analyzed using SPSS 27.0. A logistic regression was done to study the effect of bradycardia, age, gender, and BMI on mortality in the study group. Results 24.9% patients had absolute bradycardia while 13.0% had profound bradycardia. Patients with absolute bradycardia had an odds ratio of 6.59 (95% CI [2.83–15.36]) for mortality compared with individuals with a normal HR response. The logistic regression model explained 19.6% (Nagelkerke R2) of variance in the mortality, correctly classified 88.6% of cases, and was statistically significant X2 (5)=47.10, p < .001. For each year of age > 18, the odds of dying increased 1.048 times (95% CI [1.25–5.27]). Conclusion The incidence of absolute bradycardia was found in 24.9% of the study cohort and these individuals were found to have a significant increase in mortality.

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INTRODUCTION: Cryptococcus pneumonia (CP) has a variety of radiographic presentations. Herein we share and describe an interesting radiographic case of immunocompetent CP where initial diagnostic momentum suggested primary lung malignancy. CASE PRESENTATION:A 47-year-old female with a 15-pack year smoking history presented with subacute chest pain radiating to her back along her left side. CT Chest revealed a large left pleural based upper lobe mass measuring in the axial plane with lymphadenopathy at stations 4L, 7, and 11L (Image 1). Differential diagnosis included neoplastic process versus atypical infection.Endobronchial ultrasound-guided biopsies of stations 4L, 7, and 11L were negative for malignancy. A percutaneous core needle biopsy of the left upper lobe mass was done thereafter. Pathology for the core biopsy was positive for cryptococcus gattii (Image 2 and 3). Serum cryptococcus antigen was positive with a titer of 1:5120. MRI Brain was normal, lumbar puncture was positive for cryptococcus antigen. Work up for HIV, tuberculosis, coccidiomycosis, blastomycosis, histoplasmosis, and aspergillosis were all negative.DISCUSSION: Cryptococcosis pneumonia is an uncommon infection worldwide typically due to inhalation of spores from contaminated soil and bird droppings. It compromises 20% of all fungal infections, second to aspergillus. Dissemination from the lungs to the CNS in immunocompetent hosts is exceedingly rare and thus routine lumbar puncture is not indicated. A case series of 166 patients demonstrated that serum titers greater than or equal to 1:512 had a high pretest probably for CNS invasion. Radiographic features of CP include hilar or mediastinal lymphadenopathy with lobar infiltrates, or solitary or few well defined, non-calcified nodules that are typically pleural based. A retrospective analysis of 76 immunocompetent patients with PC showed that most patients were less than 50 years of age and without preexisting lung disease.Cases describe cryptococcal masses resulting in superior vena cava obstruction or Pancoast's syndrome, both of which were satisfactorily treated with lobectomy and antifungal therapy. A case series exists where 3 of 7 patients with immunocompetent pulmonary cryptococcus required lobectomy. The 3 patients had masses measured at 12 cm, 3 cm, and 1.7 cm. The patient with a 1.7 cm mass had pulmonary hemorrhage and hemoptysis and thus urgently required resection.CONCLUSIONS: Immunocompetent pulmonary cryptococcus is rare and has a variety of radiographic presentations. Though malignancy is on the differential given the radiographic findings, it is important to recognize atypical infections can present this way. Investigating for CNS invasion is not typically indicated but when titers are extremely elevated it is prudent to pursue lumbar puncture.