Age: 60.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Light chain analysis normal, Lipase normal, Metabolic function test, Myelosuppression, Nephrotic syndrome
Clinical narrative: Suspect developed neutropenia, anemia and thrombocytopenia: Patient received COVID vaccine, Pfizer 1/7/2021 1/27/2021 patient was admitted at Hospital with pancytopenia 1/29/2021 bone marrow biopsy revealed a cellular bone marrow consistent with aplastic anemia 1/27/2021?2/12/2021?remained pancytopenic needing blood and platelets and ANC was 0 2/3/2021 (as outpatient) WBC 1.2, ANC 0, hemoglobin 8.6, platelet 56 2/12/2021 (as outpatient) received pegylated filgrastim 6 mg subcu 2/13/2021?4/2/2021: Hospital admission for treatment of aplastic anemia work-up including rheumatoid (ANA, ANCA, C3, C4) and ID work-up (EBV less than 1000, HHV-6, hepatitis panel negative, HIV negative, HTLV, parvo B19, CMV, Aspergillus, Fungitell negative) 2/13/2020 1 repeat bone marrow flow and histology had an adequate specimen; received IVIG x1 2/14/2021 WBC 0.4, ANC 0, hemoglobin 7.5, platelet count 58 on admission at medical city 2/15/2021?2/19/2021 ATG x4 doses plus Solu-Medrol 100 mg daily, subsequently tapered 2/16/2020 1 repeat bone marrow showed flow negative, pathology consistent with aplastic anemia with 2% cellularity with absent hematopoiesis 2/22/2021 low-dose cyclosporine 25 mg twice daily?tolerating well, cyclosporine level was kept low due to renal insufficiency 3/6/2021 subsequently started Prograf, discontinued on 3/11/2021 due to rash 2/25/2021 started Granix daily 2/27/2021 started Promacta 3/22/2020 1 repeat bone marrow biopsy morphology showing cellularity 5 to 10%, islands of residual T lymphocytes consistent with aplastic anemia 4/2/2021 WBC 12, ANC 11, hemoglobin 7.6, platelet count 28 on discharge at medical city, requiring platelet and blood transfusions once a week  Other: 1.  New rash started 3/5/2021?discontinued or changed meds, ultimately started on prednisone 2.  Renal failure Work-up ANCA negative, anti-GBM antibody negative, ANA negative, light chain ratio normal, UPEP/IFE negative, dsDNA negative, RPR negative, anti-PLA 2R antibody negative, renal ultrasound showing echogenic kidneys consistent with medical renal disease History including CKD stage IV, baseline creatinine is close to 3, she developed sudden onset hypertension, proteinuria and renal failure about 4 years ago and that biopsy showed interstitial nephritis and nephrosclerosis On admission, creatinine is increased range 2.4-3.2 3/19/2021 ultimately worsening renal insufficiency with creatinine into the fives along with volume overload, nephrotic syndrome with 13 G/24 and a line was placed Hemodialysis #1 on 3/20/2021?3/22/2021, subsequently changed to dialysis as needed Currently off dialysis 4/28/2021 with creatinine around 6 3.  Cardiac: Echo within normal limits 4.  Pulmonary: CT chest showed small calcified nodules, central bullae, on room air no issues 5.  Hypertension: Norvasc, olmesartan 6.  Hypothyroidism, on Synthroid 7.  GI: Hepatic transaminitis with abdominal ultrasound on 3/19/2021 showing CBD dilatation, HIDA scan showing gallbladder ejection fraction 11%, exam negative and normal lipase