Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Haemophilus test positive, Immunosuppression, Ischaemia, Neck pain, Overdose
Clinical narrative: Patient vaccinated 3/17/2021, admitted 8/9, tested positive for Covid 8/9 left AMA 8/16/2021   History Of Present Illness A 57 y.o. homeless male, smoker, with a PMH of AIDS (CD4 102 on 7/31), CAD s/p CABG and PCI, HTN, polysubstance abuse who presents with a chief complaint of dyspnea and chest pain. Of note, he presented for similar concerns yesterday and left AMA and was also previously admitted from 7/31 - 8/1 for chest pain, fentanyl overdose and an AKI. He was evaluated by cardiology during this time who felt his elevated troponin was due to global ischemia from polysubstance abuse. His chest pain was reproducible and felt to be secondary to costochondritis and chronic cough possibly from undiagnosed COPD. His CXR did show interstitial infiltrates that had been present since February 2020 so PJP, beta glucan and sputum cultures were obtained. Beta glucan was elevated and sputum cultures eventually grew H. Influenzae but PCP testing was negative. He was discharged in stable condition.    Further history unable to be obtained from patient as he is sleeping and rouses to provide one word responses but refuses to wake up and participate further. He does endorse coming in for "his breathing" and also for his chest. According to ED provider note, the patient reported "intermittent chest pain and a cough productive of white/yellow sputum" since last discharge. Also reported noncompliance with anti-retrovirals and bactrim prophylaxis. Denied fever, palpitations, lightheadedness, N/V or diarrhea or any other symptoms.  LEFT AGAINST MEDICAL ADVICE   Hospitalization Admit Date/Time: 8/9/2021  5:00 AM  Discharge Date: 08/16/21     Chief Concern, Brief History of Present Illness, and Hospital Course   57-year-old gentleman with past medical history of HIV, coronary artery disease SP CABG, hypertension polysubstance abuse presented with complaint of having chest pain and dyspnea. Upon arrival, Pt was hemodynamically stable with BP 130/90, RR 21, HR 90 and Temp 36.8. Labs were remarkable for Hb 11.5, WC 3.16, Plts 117, Na 133, K 4.2, BUN 18, Cr 1.04. Patient was incidentally found to be COVID positive and was admitted for it. For COVID-19 in setting of Johnson & Johnson vaccination, Patient did not require any oxygen and was not started on dexamethasone and remdesivir.  Patient was given regeneron on 8/13 as per ID reccs.  Patient has COVID-19 infection in setting of immunosuppression and will require quarantine for 20 days Patient has history of bipolar schizophrenia and is impolite staff.  Psychiatry was consulted and patient has been uncooperative with them.   Patient is complaining of having persistent neck pain and was started on Neurontin along with Tylenol, ibuprofen and baclofen.  Neurology was consulted who recommended MRI with further evaluation as O/P as no acute finding present. Infectious disease was consulted and patient was started on Geneovya, Bactrim and valacyclovir.   During entire hospital stay, pt had extensive behavioral issues. He was impolite towards hospital staff, was swearing and cursing at nurses, had threatening attitude, had frequent outbursts of profanity. He was repeatedly counseled to have nice attitude and behavior towards staff. He was counseled at least three times not to leave against medical advise. Tried to find a place where patient can quarantine safely and not be a risk to heath of others, called mayors office, local charities and multiple other places but were unsuccessful. Pt was not happy with care he was getting and was unhappy about the fact that hospital cannot arrange place for him.  Pt was extensively counseled to complete his quarantine in hospital but was was unwilling and wanted to leave. He was provided with clothes, list of his appointments and medication. He was unwilling to sign AMA papers and left against medical advice.