Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: White blood cell count increased
Clinical narrative: Pfizer Dose 1 3/8/21 (EN6199) Pfizer Dose 2 3/31/21 (EN6207) Pfizer Dose 3 10/6/21 (NA) COVID Positive 1/26/22  1/26/22: -Patient is an 82 yo female with medical history of Autoimmune hemolytic anemia/ Iron deficiency anemia  f/u Dr,  DM,HTN,  Hypothyroidism,GERD, HLD, Rheumatoid arthritis, BPPV  -She is presenting with progressively worsening left eye lid swelling , pain and redness which started on monday . She also has generalised facial swelling  -She does not recall history of trauma. Has left eyelid pain but denies chemosis , decreased vision , pain on moving the left eyeball , fevers, chills . She does have clear secretions from her left eye and jaw and cheek pain. Left eyelid now very swollen that she is unable to open her eyes.  -She has been on steroids for the past 2 week for AIHA. The dose was decreased from 60mg daily to 40 mg daily by Dr today because of concerns for orbiltal cellulitis. She was referred to the ER for further evaluation of her eye and face.  -In the ER her BP was borderline low, afebrile , mildly tachycardic 90-100 with normal saturation on room air  -Imaging showed left periorbital and preseptal soft tissue edema without retrobulbar abnormality or significant sinus abnormality and questionable scleral enhancement on the left.Right maxillary and left anterior ethmoid sinus disease was also seen.  -CT soft issue neck showed Multiple bilateral pulmonary nodules, not significantly changed.  Additional follow-up recommended in approximately 12 months.Enlarged paratracheal predominant mediastinal lymph nodes which have not significantly changed. Interval increase in size in pericardial lymph nodes nearby the right atrium.  -Labwork significant for mild pseudo hyponatremia, glucose 297, AKI Cr 1.16, T bili 2 with normal LFTs , lactate 6.6> 4.9, wbc 30, Hb 9 ( at baseline) , elevated ESR and CRP.  -ER provider consulted opthalmology ( Dr ) and they will evaluate patient  -Patient received Unasyn and Clindamycin in the ER. Received 2.5L fluids  2/10/22: Patient is 82-year-old female with past medical history chronic anemia due to autoimmune hemolytic anemia on prednisone following up with Dr., rheumatoid arthritis, hypertension, hypothyroidism, and type 2 diabetes mellitus.  Admitted to hospital for acute hypoxic respiratory failure due to COVID-19 pneumonia, hospitalization was complicated by left preseptal cellulitis, herpes simplex keratitis of left eye, acute on chronic anemia requiring blood transfusion and strep to coccus pyogenes, under the guidance of Pulmonary Medicine, Infectious Disease and Ophthalmology patient was treated with appropriate medical therapy and supplemental oxygen. As time progressed patient clinically improved, prior to discharge patient completed IV antibiotics, repeat blood cultures are negative to date.  Per Ophthalmology recommendation, patient will be discharged home with erythromycin ointment, and valacyclovir for total course of 7 day.  Patient recommended follow-up with Pulmonary Medicine in 2-4 weeks, PCP within 1 week, ophthalmology within 1-2 days after discharge.  Patient has also been referred for VNA including RN, PT and OT