Age: 72.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anti-ganglioside antibody positive, Antineutrophil cytoplasmic antibody negative, Antinuclear antibody
Clinical narrative: Patient is a 73 y.o. female patient of MD with a history of PMR on chronic prednisone, paroxysmal atrial fibrillation on Eliquis, postmenopausal bleeding s/p surgical hysteroscopy, endometrial ablation/IUD insertion 8/17/23, T2DM, GERD, Urinary Incontinence who presented to Hospital 9/13/2023 with generalized weakness, and two weeks of URI symptoms. She was found to be positive for COVID (9/14/23). Was transferred to the ICU with impending respiratory failure, she was intubated on 9/17/23.Found to have GBS, neurology and PMR followed. IVIG treatment began. Palliative care followed and ultimately with further decline was transitioned to comfort care and compassionately extubated 9/26/23.  Acute Hypoxic Respiratory Failure -Suspected due to aggressive Guillain Barre progression  -Intubated 9/17 due to impending airway compromise -CTPA 9/17: No evidence of PE. Mild GGO, evidence of PAH, decreased Cardiac Output.  -Patient will likely require tracheostomy de to AIDP/GBS prognosis if aggressive care is desired -Methylprednisolone 40 mg x 10 days (EOT 9/27/23) for Covid hypoxemia -Acute change in mental status, not responding to pain. CT head on 9/24 with no acute intracranial process.  -Compassionately extubated 9/26/23 and passed.    Guillain Barre Syndrome -Suspected due to Covid, bloody diarrhea (Possible C. Jejuni) -Ganglioside Monosialic Antibody panel was lipemic. Second Panel still pending. -PMR completed NCS/EMG highly consistent with AIDP (Guillain-Barre Syndrome) concerned will need trach and LTAC placement when medically ready in addition to PEG.  -Neurology consulted for further evaluation, appreciate recommendations. Started IVIG, rate decreased due to suspected hypersensitivity reaction. No further need for LP. -Gabapentin 300 mg TID for neuropathic pain. Continue oxy Q4 with break through diluadid. -IVIG 0.4 gm/kg x 5 days. Premedicated with benadryl and tylenol, slowed rate and response well. -GOC per above.   Quadriparesis Respiratory Weakness -Suspect Secondary to GBS. With PRM, much less likely to be other etiology -Myasthenia Gravis panel pending, Myositits Myo Marker Panel pending  -MRI (9/14/23) and CT Head (9/14/23) Negative for acute infarct or acute intracranial process. Further imaging as above. -CK, ANA, DS-DNA, ENA, P-ANCA all WNL. -MRI Pan scan 9/18 primarily unremarkable -Management as above.   Takotsubo Cardiomyopathy HFrEF -Likely secondary to GBS. Possibly secondary to Covid 19. -TTE (9/18/23) showing apical hypokinesis and LVEF of 28%, no noted LVOT   Covid 19 Infection  -Positive PCR (9/14/23), reportedly experiencing upper respiratory illness for 2x weeks prior to admission -Urine Culture growing GBS (9/13/23) -CXR (9/17/23) with no active disease -Bcx, Sputum Culture NGTD -Isolation removed (9/20/23)    Sinus Tachycardia -Likely in the setting of cardiac arrhythmia's due to GBS, pain  -EKG (9/17/23) NSR, non acute. Patient prior to intubation with no chest pain. -ECHO as above. EKG (9/20/23) Non acute