Age: 57.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Asthenia, Asthma, Blood alkaline phosphatase increased, Blood creatinine increased, Blood culture
Clinical narrative: Hospitalized (11.15.21);  COVID-19 positive (11.15.21 and 11.21.21);  fully vaccinated CHIEF COMPLAINT: Pneumonia due to COVID-19 virus HISTORY OF PRESENT ILLNESS: Patient is a 57 y.o. female with a PMH significant - no longer on C-pap, Bariatric surgery with subsequent abdominal abscesses/shock/ARDS/anoxic brain injury, Seizure disorder,  PE/DVT on Xarelto, Lymphocytic Colitis, PUD, and Asthma who presents today with severe generalized weakness, rigors, anorexia and dyspnea.  The patient's father has been diagnosed with COVID-19 and the patient lives with him.  She states that mild symptoms started last week on 11/11 with rhinorrhea and poor appetite.  She has gradually worsened to the point in which she had rigors overnight and was too weak to get out of bed today.  She has a very mild cough but notes dyspnea.  She notes nausea without vomiting. She had diarrhea at baseline which has not changed. Today she had one episode of bright red hemoptysis while coughing.  She is recovering from right rib fractures in which she describes a burning nerve pain to her right ribs.  The patient also endorses dysuria.  The patient had COVID-19 in January, 2021.  She received mono-clonal antibodies and did not require hospitalization.  She was then vaccinated x 2 with the Pfizer vaccine (last dose 5/2021).  On chart review, the patient was on Budesonide at the time of the vaccine. In the ER, the patient had T 37.2 C, hypoxia with SpO2 of 86%, RR 26.  Other vital signs were normal.  CXR overall low inspiratory volumes with areas of confluent bilateral mid and lower lung predominant airspace opacities suggesting Covid pneumonitis.  Labs significant for creatinine 1.11, magnesium 1.3, alk-phos 234, AST 70 ALT 86, WBC 14.84.  The patient was given 1 g of Tylenol, 6 mg of Decadron, 2 g of magnesium sulfate.  ASSESSMENT / PLAN: Pneumonia due to COVID-19 Acute Respiratory Failure with Hypoxia Asthma -Previous case of COVID-19 s/p monoclonal antibodies January 2021, Vaccinated with Pfizer x 2 (last dose 5/14/21) -CXR overall low inspiratory volumes with areas of confluent bilateral mid and lower lung predominant airspace opacities suggesting Covid pneumonitis.  -Date of onset 11/11/21 -Symptoms: Fatigue, generalized weakness, rigors, anorexia, rhinorrhea, dyspnea, mild cough. -Treatment: Remdesivir (started 11/15), Decadron (started 11/15), VTE prophylaxis with home Xarelto, Albuterol inhaler scheduled Q4 w/a, supportive care with PRN anti-emetics, PRN anti-pyretics, PRN anti-tussives, Prone PRN -Given leukocytosis at admission - monitor blood cultures DISCHARGED 11.22.21 Admission Date: 11/15/2021 Discharge Date: Nov 22, 2021 PRESENTING PROBLEM: Hypoxia Pneumonia due to COVID-19 virus HOSPITAL COURSE: 57-year-old female with past medical history of bariatric surgery (complicated by abdominal abscesses, shock, ARDS, anoxic brain injury), seizure disorder, PE/DVT on Xarelto, lymphocytic colitis, peptic ulcer disease and asthma.  She presented on 11/15 with COVID 19 related symptoms including weakness, rigors, anorexia, dyspnea, cough.  Her father had tested positive for COVID earlier in the week.  COVID PCR is positive. On arrival to emergency department she was placed on 3 L of oxygen.  Chest x-ray shows bilateral mid and lower lung predominant airspace disease consistent with COVID.  Labs were notable for mild leukocytosis, elevated procalcitonin elevated creatinine and mild transaminases elevation.  Of note patient is vaccinated against COVID.  She started on Decadron and remdesivir admitted to Medicine Service for further assessment and management.  Patient's oxygen requirements remained stable between 3 and 4 L. she was found to have a urinary tract infection and was treated with Rocephin.  Urine cultures did grow E coli sensitive to Rocephin.  Patient remained compliant with Xarelto based on her history of DVT.  Physical therapy cleared patient to go home with services.