Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Depressed mood, Febrile neutropenia, Haemoglobin decreased, Haptoglobin increased, Head injury
Clinical narrative: Pfizer Dose 1 2/11/21 (EN6201) Pfizer Dose 2 3/11/21 (EN6204) COVID Positive 8/7/21 Hospitalized 8/5/21-8/9/21 Presented to and discharged to home from ED 8/10/21  8/12/21: Patient is a 75 yo female with medical history of breast cancer on chemotherapy , HLD, HTN, Hypothyroidism , Depression , Obesity  She is presenting after a syncopal episode at home. She states since yesterday she has not been feeling very well , she had an episode of non bloody emesis and passed out hitting her head. She was able to get 911 to bring her to the hospital. Of note she was recently admitted 8/5-8/9 for Neutropenic fever for which she received one dose of neupogen with improved counts . During that admission she tested positive for COVID. She was supposed to visit her PCP today about plans for possible monoclonal antibody infusion but she got admitted to the hospital. She follows Dr her last chemotherapy was 3 weeks ago and it was halted because she was hospitalized  She has not had a BM in the past 2 days. Denies abdominal pain , SOB, chestpain. She lives alone and ambulates with a walker. In the ER her vitals were stable. Labwork was remarkable for Hb 3.7 (last Hb was 8.8 on 8/10)  , wbc 1.4 , normal platelet , UA negative , normal coagulation profile, potassium 3.1 , normal lactate, elevated LDH and haptoglobulin , normal pro BNP. She was transfused 1 unit pRBC in the ER  Discussed with Dr who recommended starting her on neupogen 480mg SQ for 5 days until wbc > 15000.  8/15/21: The patient known to have metastatic breast cancer on chemotherapy, presented to the hospital with episodes of syncope and she found to be dehydrated and initially her hemoglobin was 3.7 and thoughts that was the cause of the syncope and she received 2 unit of packed red blood cell with hemoglobin improved to 10.9, most likely the initial hemoglobin result was hemodiluted.  She had fever with chills and cough, her COVID 19 test is positive.  She had chest CT angiogram show no pulmonary embolism and show bilateral pneumonitis. She did not had hypoxia and she was not candidate for steroids or IV antiviral therapy. Continue her supportive therapy with vitamins and IV fluid and Tylenol.  Initially she presented with severe leukopenia, the oncologist consulted and he recommend neupogen subcu and she received it with improvement in her leukopenia.  Patient initially started on vancomycin and Zosyn due to sepsis with leukopenia and neutropenia/immunocompromised due to chemotherapy.  Blood culture are negative so antibiotic stopped. Discussed with the oncologist, the workup for DIC and acute coagulopathy is negative, okay to discharge the patient with supportive therapy and follow-up with him at the clinic with repeated labs.  The patient had hypokalemia and hypomagnesemia which replaced p.o. and IV.  The patient feel depressed without suicidal ideation, started on mirtazapine 15 mg HS. Patient is not candidate for nursing home.  Discussed with the patient, will discharge the patient home, take Tylenol and vitamins and improved p.o. intake, will send the patient home with nurses and COVID-19 safe home program and follow-up with her oncologist.