I wanted to share this if anyone would like to improve or use this in their HA/Node Red system:
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Basically, with the HA PS5Mqtt addon you can get sensor values from your Playstation 5. You can template out some attribute sensors for Game Name, Game ID (Playstation, not SteamgridDB), etc. I then had it so whenever the PS5 turns on, it will grab the game name attribute from the activity sensor, then go into SteamGridDB and search for Game ID by Title, then pull that game id into a similar api query for the Game cover. You can set query params to find cover size or style (You need the SteamgridDB api key, so an account is necessary). I then get the payload result and return it back into a home assistant sensor to do with it as you please.
For my example I created a generic camera which when the ps5 is off will show a static image, and when the MQTT is detected on the camera will load from this flow to a steam grid db cover.
Any improvements are welcome as this is made by a guy who is not a programmer by trade.