Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Culture negative, Disseminated intravascular coagulation, Drain placement, Drain removal
Clinical narrative: Vaccinated in March, began having some mild shortness of breath and fatigue around mid April which she attributed to allergies. Fatigue and shortness of breath continued to worsen and she began having some lower extremity edema. She saw her family physician at the time, Dr., who did an EKG in the office which was normal, and recommended that she follow up with Cardiology. In May the shortness of breath and fatigue worsened and she began having pain between her shoulder blades. She saw the Dr. He did a cardiolyte stress test which was reported as negative, and an echo which showed a mild pericardial effusion and they recommended a follow up echo in 3 weeks. Her blood pressure was also elevated so she was started on Metoprolol. Colchicine was prescribed for the pericardial effusion. About two weeks after that visit (which would be early to mid May) she developed chest pain and shortness of breath so severe that 911 was called and she went to the hospital. It was reported to us that her troponin was elevated and she was transferred to another Hospital. There she was seen by a doctor, the inpatient cardiologist for ACS. Dr performed a heart cath, which was clean-"pristine" was the wording he used. While there a transesophageal echo was done which showed severe aortic insufficiency with vegetation on th aortic valve. She also had bilateral pleural effusions in addition to the pericardial effusion. Dr. a CV surgeon, was consulted. At that time, the presumptive diagnosis was that the pleural and pericardial effusions were related to CHF from severe aortic insufficiency, and infective endocarditis. However, blood cultures were negative. She underwent an open AVR 5/27/21. Her aortic valve was sent to infectious disease for culture (negative). Several more sets of blood cultures were also negative. Dr. reported to us that he drained over 1L from the sac around her heart during surgery. The operation was a success and she had an uncomplicated hospital stay of 4 days, except for persistent anemia and thrombocytopenia requiring multiple transfusions. 4 days after discharge she had another episode of chest pain and shortness of breath which resulted in another ER visit, this time to a different hospital. A large pleural effusion (1400cc) was drained (bedside thoracentesis) from the left lung. A repeat echo showed that the bioprosthetic valve was functioning normally but there was again a pericardial effusion. She was readmitted to the hospital. At our insistence, critical care medicine was consulted. Dr. did a thorough interview and history and was concerned about a possible vaccine reaction. Hematology/Oncology, Rheumatology, Infectious Disease, Internal Medicine, and Cardiology were all following, but no one was able to determine a cause for the effusions or persistent anemia and thrombocytopenia. The pericardial effusion continued to worsen and the Dr. performed a pericardial window on the left through a VATS. A large pericardial effusion then developed on the right. Medical treatment with colchicine failed and Dr. added Ivermectin and steroids. Eventually, the right pericardial effusion progressed to tamponade and cardiology placed a pericardial drain. Eventually, the output of the chest tubes and pericardial drain diminished and these were removed, however the anemia and thrombocytopenia persisted. A diagnosis of DIC was reported to us by Hematology/Oncology. Initally, platelet counts responded to decadron, and so prednisone was increased to 1mg/kg/day (60 mg). Around July 1, the hospital told us there was nothing more that could be done and she was discharged from the hospital. She is being followed by Dr. and hematology. On July 6 her platelet count was 30K (40K at discharge) but her hemoglobin had improved to 10. Of note, there is a small opacity I think in the right upper lobe that will have to be looked at later, but they do not feel that this is contributing to her symptoms. She is at home now with O2 NC at 2L, home health, and physical therapy. She remains fatigued and short of breath.