Age: 36.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Viral test negative, White blood cell count increased
Clinical narrative: Hospitalized 12/16/2021; COVID-19 positive 12/7/2021; fully vaccinated  BRIEF OVERVIEW:   Discharge Provider: Doctor Primary Care Provider: Doctor Admission Date: 12/16/2021 Discharge Date: Dec 20, 2021 DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Hypoxia Acute hypoxemic respiratory failure    HOSPITAL COURSE: per HPI:  Patient is a 37 y.o. male with a past medical history significant for obesity, tobacco abuse and marijuana abuse who presents today with a chief complaint of shortness of breath.  Patient reports that his symptoms began about 2 days ago.  He endorses fevers, chills, diaphoresis, anorexia, dry cough, shortness of breath and diarrhea.  He states the shortness of breath as stressed clear worsened since yesterday which is what prompted evaluation in the emergency department.  He denies chest pain, palpitations, diaphoresis, lightheadedness or dizziness.  Denies lower extremity swelling, orthopnea or paroxysmal nocturnal dyspnea.  Denies nausea, vomiting, abdominal pain, dysuria or hematuria.  Patient reports he has been vaccinated with 2 doses of Moderna in May of this year.  He denies personal history of blood clots.  Endorses smoking approximately 2 cigars daily and drinking 1/2 pt alcohol every other day. Patient seen and examined in the emergency department on 12/15/2021.  Chest x-ray obtained concerning for pneumonia, likely related to COVID-19 virus, despite negative testing.  Patient given information regarding the monoclonal antibody infusion clinic.  Also prescribed an antitussive and given a pulse oximeter to monitor his oxygen levels.  Patient discharged home in stable condition at that time. Upon presentation to Emergency Department, the patient had low-grade fever, tachycardia, tachypnea and was hypoxic 89% on room air.  CMP was unremarkable.  Complete blood count demonstrated a mild leukocytosis of 12.17.  Procalcitonin normal.  NT-BNP normal.  Viral PCR negative including COVID-19.  Peripheral blood cultures were collected, no growth thus far.  Chest x-ray demonstrating multifocal ill-defined opacities throughout bilateral lungs.  CTA thorax excluded pulmonary embolism.  Reconfirmed diffuse patchy airspace disease scattered throughout both lungs.  Mild mediastinal and bilateral hilar adenopathy.  Patient received a dose of Rocephin and doxycycline in the ER.  He will be admitted to the hospital as inpatient status in stable condition for further monitoring and treatment. in-house:  patient admitted for severe sepsis secondary to a viral pneumonia with acute hypoxemic respiratory failure. severe sepsis acute hypoxemic respiratory failure viral pneumonia  concern that this was COVID with a false negative test. bilateral pneumonia on CTA thorax, elevated CRP, had a leukocytosis on admission which is not typical for COVID but did have a lymphopenia which IS typical for COVID; furthermore patient had loss of taste in addition to the usual slew of viral symptoms such as diarrhea and loss of appetite. did test positive for metapneumovirus, procalcitonin negative. he was given two doses of ceftriaxone and three doses of doxycycline, antibiotics were subsequently stopped. he was started on steroids and remdesivir, remdesivir was not continued due to the negative COVID test. he was also transferred to a COVID unit. he improved progressively after that, was given a dose of lasix to facilitate weaning with good results. patient was weaned to room air on 12/20 and then ambulated, with no significant desaturation on exertion. diarrhea presumably 2/2 above, c.diff negative, managed supportively with improvement. at the time of discharge patient was in good spirits and eager to leave. his only complaint was his cough, which had improved a bit since admission. eating, ambulating, and eliminating well. all questions and concerns addressed, all meds and follow-ups reviewed.