Age: 59.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Anticoagulant therapy, Barium swallow normal, Blood culture negative, Blood lactic acid increased, Chills
Clinical narrative: Before June 14,2022 I was perfectly healthy. Woke up in the middle of the night with acute symptoms of shortness of breath, shaking chills, Fever to 102, spastic coughing, hypoxia. Admitted to hospital 6/15/22-6/24/2022 with diagnosis of acute Bilateral  lower lobe pneumonia, and small PE could not be excluded in LLL so MD aired on the side of caution and started Eliquis for 3 months. . Had 7 day course of IV Unasyn, and IV Zithromax. During this hospitalization was treated also with IV steroids, Nebulizer treatments, supplemental O2. Discharged on 6/24/2022 not feeling that great. Discharged on Prednisone taper. ON 7/1/2022 again developed acute sudden symptoms of spastic coughing, fever, chill, shortness of breath On 7/1/2022 Developed sudden acute symptoms again of spastic coughing, shortness of breath, fever, chills, O2 saturations down to 83% and vomiting. Admitted to hospital again 7/1/2022-7/7/2022. In ER had Lactic Acidosis, Procalcitonin level 0.38.  Diagnosed with recurrent pneumonia, Leukocytosis, and shortness of breath. O2 saturation 87%.  Treated with IV Vancomycin, IV Cefepime. Discharged 7/7/2022 on Ceftin 500mg, 1 tablet my mouth twice a day for 1 day to complete my 7 day course of antibiotic therapy. Presented to ER on 8/4/22 again with same presenting symptoms same as before. Since there was only mild leukocytos and no elevation in Lactic Acid or Procalitonin was discharged from ER and sent home Oral Zithromax and Ceftin. I had office visit with Dr., pulmonologist who feels that I have COP- Cryptogenic  Organizing Pneumonia. Treatment for this is long course of steroids for 3 months. Before starting steroids, he wanted me to have a bronchoscopy. Washing were completely negative, no abnormal fungal findings. A few days later started Prednisone 40mg Daily for 3 months. On 8/15/2022 presented with same symptoms as previously mentioned above. Admitted 8/15/2022-8/19/2022 with pneumonia, Acute hypoxemia, and Respiratory Failure. O2 saturations in ER 85-88%. Required supplemental oxygen. Procalcitonin initially 0.09 in ER, but when rechecked on 8/16/2022, it was elevated at 1.21.WBC was 20.68 in the ER. Lactic acid was 2.3. Fever of 101.4. While still in the ER on 8/15 a recheck Lactic acid level was 3.0, Chest CT showed confirmed multilobar airspace disease, demostrating significant progression when compared to previous study, ID was consulted. Started on IV Vancomycin, IV Doxycyclien, and IV Cefepime. The IV vancomycin was discontinued a couple of days later as a repeat MRSA screen was now negative. I had modified barium swallow done that did not show any signs of aspiration. I had an EGD that showed esophagitis, no strictures. I do have a history of Barretts esophagus. Protonix was increased to 40mg BID. Also treated with IV steroids Supplemental O2. Discharged on 8/19/2022 on Levofloxacin 750 mg for 7 days. Then on day 8 started on single strength Bactrim Daily for the next 4 months. I was also discharged on O2 2 liters at night. (never wore Oxygen before) nebulizer treatments QIDPulmonologist increased the length of time on prednisone.. I am now to be treated with Prednisone 40mg Daily for a total of 4 months, I saw the hematologist on 9/1/2022 to get set up for an Iron infusion for known history of Iron deficient anemia. That morning, I woke up again with severe spastic coughing, Shortness of breath,  Fever, Shaking chills, pain in lungs, and sore throat. My hematologist agrees with the diagnosis of Cryptogenic Organizing Pneumonia, and he strongly feels all this is related to the 2nd COVID vaccine I received on May 19, 2022. I was sent to ER from Hematology office. WBC-22.90, Lactic acid 2.6. Chest CT showed Improvement in the previously seen nodular and ground-glass opacities in both lungs likely resolving pneumonia or Alveo hemorrhage. Dr., pulmonologist, was pleasantly surprised that the Chest CT showed improvement. He feels the steroids for treatment of COP starting to work. No need for any further antibiotics as gold standard treatment for COP is Long term steroids. I was given 3 liters of IV fluids in the ER and was discharged home that day. I am a type 2 diabetic, and my blood sugar has been in the 400s from the steroids. I see endocrinology now. I am on a lot of insulins, but that is okay because I absolutely have to be on the steroids for 4 months to treat COP.  It is important to note that before June 14, 2022 I was perfectly healthy. Every single time I was COVID negative, and I have never had COVID. I work for the agency in Home-based primary care. I am a Nurse. My life has been turned upside down. FMLA was approved, but I had no further Sick Leave, Annual leave left. Absolutely nothing to use as time to get paid.  Entire medical work was negative. Negative blood cultures every single time, no findings on bronch. washings, COVID PCR test negative everytime. THrough work I get PCR tested twice a week, and has never come back positive. To be chronicly sick like this with no real medical findings since June 14, 2022 as effected my emotional well being. I have been off work.  Based on my symptoms being treated for COP. I still get short of breath with exertion. I still have to wear supplemental O2 at night, Still on nebulizers treatments. I just want to be healthy again. Will be on Prednisone 40mg Daily for 4 months along with single strength Bactrim daily for the next 4 months. After the 4 months, whenever they start the steroid weaning, I can come off the Bactrim when Prednisone dose is under 20mg daily. Then to have a small PE as well. All of this min boggling. The only thing that makes since it is from the 2nd COVID Booster shot I received on May, 19, 2022. My Phycians strongly feel that it is related to this as well.  Also I will be starting pulmonary rehab on 9/8/2022. Below is a list of my treating MDs:  MD, Pulmonary and Critical Care  MD, ( Hematologist)  MD, for diabetes and Endocrine Health Hospital, All of my hospital admissions have been here.  MD infectious disease