Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Blood creatinine increased, Blood culture negative, COVID-19, Chest X-ray normal
Clinical narrative: Patient is a 39 y.o. female with a history of CVID on IVIG, IgA deficiency, aseptic meningitis, chronic pain, adrenal insufficiency, asthma, pancytopenia, Behcet's, and CLABSI who presented to Hospital 10/31/2023 with fever starting 10/26/23 and upper respiratory symptoms starting 10/27/23 with Tmax 104 at home. Tested positive for COVID 19 on 10/30/23 outpatient. Admit labs with acute on chronic pancytopenia, Cr 1.18. CXR non-acute.    1. COVID 19: Symptom onset 10/26/23 with fever. Cough, congestion followed. Tested positive 10/30/23. Not on O2, CXR non-acute. ID consulted to evaluate for therapeutics given immunocompromised state. Complete 5 day course of Paxlovid. 2. Sepsis, likely due to viral infection: Suspect secondary to above however with history of multiple CLABSI and L chest port in place, high fever, also with urinary symptoms, will continue broad spectrum antibiotics for now with Vanco/Zosyn. ID following. Blood cx NGTD. Continue IVF. Culture negative, so Abx stopped. 3. AKI: Mild, admit Cr 1.18, baseline Cr 0.8. Suspect pre-renal with poor PO intake with above. Resolved. 4. History of CLABSI: Multiple episodes of bacteremia related to indwelling port in the past, most recently 7/2023. Resumed PTA doxycycline. 5. CVID: diagnosed 2004. Follows with Dr. (Immunology) and ID. On weekly IVIG infusions qFridays. Allergy and Immunology previously followed while inpatient for consideration of IVIG. Patient plans to discharge 11/3/23 to receive home IVIG infusion as previously. 6. Oropharyngeal/Esophageal Candidiasis: With chronic dysphagia and odynophagia. Follows with GI, Dr. (ID) and ENT. S/p caspofungin in the past. Restarted on micafungin IV outpatient per ENT, ID consulted to assist with continuation. Repeat scope with ENT 11/2/23 unremarkable. Recommended stopping Micafungin, but patient insisted on completing course. 7. Pancytopenia: Baseline WBC 2?3, baseline PLT 40?60 and baseline Hgb 11?12.  Admit labs within baseline range. Monitor.  8. Acute on Chronic Pain: With migraines and neuropathy. Follows with neurology at facility s/p nerve decompressions 3/2023.  Aimovig scheduled first of every month for migraine prevention, held. OARRS reviewed, home oxycodone continued on admit.  9. Secondary Adrenal Insufficiency: continued home dose of hydrocortisone during hospitalization. Increased dose of steroids for 2 days after discussion with patient's endocrinologist. 10. Sjogren's, Bechcets, and Hashimotos: Home Plaquenil continued, steroids as above.  11. Baseline reduced mobility POA: Noted 7/2023 admit when patient underwent EMG and MG was considered. Pt followed up with neuromuscular specialist at Clinic and MG ruled out per patient/family. Walks with cane at baseline.  12. HTN: Per history, held home meds for soft BP and AKI on admit. Monitor and resume as indicated.  13. Abnormal CT: CT PE outpatient on 10/28/23 noted no PE, pulmonary web in LLL, possible subtle chronic sequela of PE, pulmonary nodule. Recommend outpatient follow up for repeat scan in 3-6 months outpatient.