Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Leukopenia, Nasopharyngitis, Oropharyngeal pain, Pharyngitis streptococcal, Pyrexia
Clinical narrative: Date of Admission  01/29/2022   Date of Discharge  01/30/2022   Reason for Hospitalization   Pt has had cold/flu symptoms forthe last couple days. Pt had fever of 102.1 @home, no Tylenol or Motrin tonight.  Hospital Course   17-year-old F with Crohn's disease, Juvenile rheumatoid arthritis, and POTS presents with 3 days of URI-like symptoms (cough, sore throat, congestion, runny nose) since 01/28. First fever 102.1 on 01/29 23:00. Family's understanding is that given her immunocompromised status and her port, that anytime she fevers, she needs to come to the ED and possibly be admitted for IV abx for possible central line infection. Patient is otherwise eating, drinking, voiding, stooling at baseline. ED course: Febrile upon arrival (38.1). Patient was given a single bolus of fluids. CBC, CMP, CXR,influenza ordered. Some leukopenia but no neutropenia. Patient given 1 dose of cefepime as this is what she reports she has gotten previously with these admission fevers. COVID and strep positive.   Following day pt was afebrile and sx improved. Given 1 dose of ceftriaxone to cover for potential central line infection, though low suspicion for this. Discussed with parents that Covid-19 and strep are likelier sources for the fever. Will continue to monitor blood cultures after discharge until at least 24 hours with no growth.  Discharge Diagnoses      1. COVID-19 virus detected  - dx: 1/30  - sx onset: 1/28  - Fully Vaccinated  - discussed case with I.D. attending Dr. who recommended sotrovimab infusion given her immunocompromised state. Patient was administered this the day of discharge  - discussed isolation precautions: patient to remain in isolation until 5 days after sx onset (2/1), then can be in public with a mask for 5 days after that (per latest CDC recommendations)   2. Strep throat  - possible colonizer, however given sore throat and fever will treat for streptococcus pharyngitis (even though Covid-19 could also be the cause for her sx)  - Rx: total of 10 days of amoxicillin (1/30-2/8)    f/u with PCP 1 week -launched   Patient seen and discussed with attending Dr   Other Diagnoses   Ongoing  Anemia, iron deficiency  Crohns disease  Iron deficiency  Juvenile rheumatoid arthritis  Migraines  POTS (postural orthostatic tachycardia syndrome)  Historical  Acute deep vein thrombosis (DVT) of left upper extremity  Central line insertion  Juvenile idiopathic arthritis      Pending Labs  Blood Culture (Preliminary, InProcess, ordered 01/30/2022, 00:27)   Blood Culture (Preliminary, InProcess, ordered 01/30/2022, 00:27)   SARS Coronavirus 2 IgG and IgM Ab (Dispatched, Ordered 01/30/2022, 03:34)     Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  SUMAtriptan (SUMAtriptan 25 mg) See instructions, Oral, Take at onset of migraine. Repeat dose in 2 hours if migraine does not improve. Do not take more than 2 doses in 1 day or 3 days in a week., PRN: as needed for migraine headache  Instructions:Take at onset of migraine. Repeat dose in 2 hours if migraine does not improve. Do not  aspirin (aspirin 81 mg) 81 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    benzonatate (Tessalon Perles 10 100 mg, 1 capsule(s), Oral, tid, do not crush or chew, PRN: as needed for cough, 21 capsule(s), 0 Refill(s)  Instructions:do not crush or chew  calcium carbonate (calcium (as 1,200 mg, 2 Tablet(s), Oral, qAM, 0 Refill(s)    celecoxib (celecoxib 100 mg) 100 mg, 1 capsule(s), Oral, bid    cetirizine (ZyrTEC 10 mg) 10 mg, 1 Tablet(s), Oral, At Bedtime    docusate (Colace 100 mg) 100 mg, 1 capsule(s), Oral, At Bedtime    folic acid (folic acid 1 mg) 1 mg, 1 Tablet(s), Oral, Daily    heparin flush (heparin flush 10 300 units, Misc, As Indicated, PRN: Port access    inFLIXimab (Remicade 100 mg int 10 mg/kg, IV, As Indicated, q7weeks.  Instructions:q7weeks.  lansoprazole (Prevacid 30 mg or 30 mg, 1 capsule(s), Oral, bid    melatonin (Melatonin 5 mg) 10 mg, 2 Tablet(s), Oral, At Bedtime    methotrexate (Methotrexate Sodi 15 mg, 0.6 mL, Subcutaneous, qSaturday    ondansetron 4 mg oral tablet, d 1 Tablet(s), Oral, q4h, PRN: AS NEEDED FOR NAUSEA/VOMITING, 21 Tablet(s), 7 Refill(s)    propranolol (propranolol 20 mg) 20 mg, 1 Tablet(s), Oral, bid, 60 Tablet(s), 11 Refill(s)    sodium chloride (Normal Saline Misc, As Indicated, PRN: Port access    sodium ferric gluconate complex IV, As Indicated, PRN: Iron Levels    zinc sulfate (Orazinc 110) 110 mg, 1 Tablet(s), Oral, tid, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 37.6 °C  TMIN: 36.6 °C  TMAX: 38.1 °C  HR: 84  RR: 19  BP: 112/67  SpO2: 100%  WT: 58.5 kg  BMI: 21.5          Follow Up Appointments      Appointment Type  When  With  Where  Contact Information  Status   RT1 03/31/2022 10:10 AM MD, Confirmed         With  When  Contact Information        As needed PEDIATRIAN       Additional Instructions:         Nursing/Other Orders   Regular Diet. Ordered on 01/30/22 2:56:00 Meal Start Time Breakfast 0700 to 0900   Up Ad Lib. 01/30/22 2:56:00  Continuous Order   Code Status. Code Status Description: Full Code     Addendum by MD on February 07, 2022 21:59:28  I have seen and examined the patient on 1/30/2022. I agree with the above PE and plan of care as discussed with the resident team. Parent updated and questions answered.  MD