Here we presented two cases of bacterial endocarditis in patients with a history of COVID-19 infection treated by tocilizumab combined with corticosteroid and Remdesivir. COVID-19 infection's main symptoms are related to respiratory system involvement, including a broad spectrum of presentations, ranging from mild upper airway symptoms to ARDS [
4,
5]. However, multiorgan involvement is a consequence of severe infection, which is responsible for mortality besides ARDS. one of the rising considerable organ involvements, which was found in 12% of patients, are cardiovascular complications, including the rise of troponin, myocarditis, blocks, arrhythmia, cardiac ischemia, heart failure, endocarditis, pericarditis and rarely reported tamponade. Compared to other cardiac complications, Myocardial injury prevalence is statistically dominant [
5,
10,
11]. On the other hand, endocarditis has a tiny share. It has been rarely reported among several cardiac involvements of COVID-19 infection with different pathogeneses and prevalence [
10,
12]. Direct action of the COVID-19 virus, the inflammatory phase of disease and cytokine storm, neurohumoral damage in the cardiovascular system, severe hypoxia, electrolyte abnormalities, increased shear stress and hypercoagulable state caused by COVID-19 infection are some of the hypothesised pathogenesis of cardiac complications following COVID-19 illness [
3,
11,
13]. However, reported cases of infective endocarditis do not support direct impaction of the COVID-19 virus or inflammatory phase [
14]. Previously reported cases raise different scenarios to explain the occurrence of endocarditis after COVID-19 infection. The first scenario is the primary presence of endocarditis, which is underdiagnosed because of the massive prevalence of COVID-19 infection and the pandemic. In this scenario, preexisting endocarditis can progress and even get worse because needed not only antibiotic administration delayed, but also immunocompromising agents are administered to treat COVID-19 infection, which can exacerbate the underlying disease [
12,
15]. In these cases, the COVID-19 PCR test can be positive or not. Although in those patients with positive PCR tests and typical clinical findings and symptoms, COVID-19 infection cannot be ruled out; therefore, preexisting endocarditis is the actual cause of illness [
16,
17]. In our cases, patients experienced an episode of symptom-free time, indicating that the main pathology was cleared and patients were cured. Then another episode of illness and somehow different signs and symptoms could be induced by relapsing the main pathogenesis or a new one. Therefore, our presented cases are not in favour of this hypothesis enough. The other scenario, supported by the presented cases in this article, is the probability of secondary infection after receiving immunocompromising agents to treat COVID-19 infection [
18]. Corticosteroids as an anti-inflammatory agent are extensively used for an inflammatory phase of COVID-19 infection, which inhibits the immune system and will raise the possibility of secondary infection or deteriorating existing infection [
19]: Tocilizumab, an interleukin 6 (IL6) receptor blocker. IL6 is a cytokine that is an essential component of the innate immune response, so blocking its action will compromise immune system function [
8]. This can predispose secondary bacterial, viral, and fungal infections in patients theoretically, which is illustrated clinically in a few studies [
8,
20‐
24]. However, primarily we should consider that several of these articles mentioned a short period of follow-up and challenging diagnosis due to mimicable symptoms and signs of COVID-19 infection as a limiting factor in the detection of secondary infections [
21,
25‐
29]. Another hypothesis mentions critical illness and intensive unit care (ICU) admission contributing to secondary infection, pushing tocilizumab administration out of the spotlight [
6]. Summing up the whole data, given that both cases presented in this article had corticosteroid and tocilizumab administration in their past medical history, the second hypothesis is highly supported in our patients of the published studies do not support this hypothesis clinically.