Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Thrombotic thrombocytopenic purpura, Transfusion, Withdrawal of life support
Clinical narrative: History per chart review and husband. The patient is a 55 Years-old Female with a history of rheumatoid arthritis, anxiety/depression, overweight who presented with acute shortness of breath. 2 weeks prior to admission she filled her routine prescription for hydroxychloroquine for her rheumatoid arthritis, however husband reports that she stopped taking this and started taking a supplement from another country called RT King and reported improvement in arthritis symptoms.  She also had congestion and sore throat around this time and tested herself for Covid with a home test that was negative. Shortly after this she was performing her job as a provider for patient that passed away from Covid and attended the funeral.  On 9/8 she reported difficulty breathing and pain in the chest and back with deep breaths.  This spontaneously resolved.  Then on 9/9 in the evening she had fever, body aches, however she attributed this to her rheumatoid arthritis and the storm pressure changes.  9/12 she felt great then played at the beach with her grandkids running around.  Then 9/12 in the evening she felt ill and took a home Covid test that was positive.  Husband took a home Covid test that was negative.  She did not initiate any outpatient care other than Mucinex and vitamin C.  9/13 in the morning she had difficulty breathing, hyperventilating, blue lips, diffuse body pain, feeling very weak to stand.  She was not drinking or caring for herself.  She was able to walk to the truck.  Her family brought her to the ER freestanding.  At the freestanding ER, she had initiated and tested positive for flu and negative for Covid by antigens.  Covid PCR later returned negative.  She was transferred to the main ER and desaturated during the transport and stopped breathing.  She maintained a pulse.  In the ER she was intubated.  Pressors Were Started to Maintain MAP. CTA was negative for PE, however ED physician and family practice physician clinically suspected PE and that there could be multiple small thrombi in the lungs rather than a large PE detectable by CTA.  She was started on heparin drip.  ICU accepted the patient and began management. She tested negative for COVID IgM antibodies and positive for COVID IgG antibodies. She devloped DIC (disseminated intravascular coagulation) and TTP (thrombotic thrombocytopenic purpura). During the hospital course she had sputum and blood cultures positive for streptoccocus pneumonia. She later had pseudomonas VAP and Enterococcus faecalis bacteremia. She had failure of lungs, liver, and kidneys. She was treated with maximal critical care management including broad spectrum antibiotics, ventilation, continuous renal replacement therapy, blood/platelet transfusions, chest tube, OG tube feedings, and anticoagulation initially that was later discontinued. She had minimal responsiveness to pain only after sedation withdrawal and was unable to breath spontaneously. On 10/9 the family agreed to palliative vent withdrawal and she expired. I suspect her severe illness may have occured due to abrupt discontinuation of hydroxychloroquine for rheumatoid arthritis and antibody dependent enhancement of influenza due to COVID vaccine.