Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Pancytopenia, Pneumonia, Pneumoperitoneum, Pyrexia, Red blood cell transfusion
Clinical narrative: Patient is a 70 y.o. male patient of, MD with history of follicular lymphoma, CAD, NIDDM2, HTN, HLD, CKD2, pericarditis and recent COVID infection who presented with fevers and hypoxia. Course complicated by perforated duodenal ulcer s/p surgical repair.   Acute respiratory failure with hypoxemia In setting of COVID, initially on 3L O2, then requiring HHFNC Off supplemental oxygen by discharge Completed steroids/remdesivir course as well as Zosyn/caspofungin   Sepsis With recurrent fevers during hospitalization Immunocompromised at baseline given lymphoma/recent chemotherapy Likely due to COVID ID followed Cultures negative, fungitel negative Treated for COVID as below and completed Zosyn/caspofungin therapy   COVID-19 viral pneumonia  Patient presented with hypoxia, has had resp symptoms/cough for 2 months  Date of covid positive test: 9/18/22 in facility, outside initial positive on 8/1/22, continued to be positive 10/4 Vaccinated and boosted, though immunocompromised CTPA on 10/9 with moderate-severe multifocal pneumonia Had received Paxlovid, then steroids on admission which were stopped due to perforated duodenal ulcer ID followed No detectable antibodies with ongoing elevated inflammatory markers which are now improving Given Evushield 10/12, remdesivir course completed, IV decadron resumed 10/15 during remainder of admission, received IVIG Off of supplemental O2, discontinued steroids    Perforated duodenal ulcer  In the setting of aspirin, decadron and acute illness  Intraabdominal free air note on chest CTA and CT abdomen (10/9)  Taken to OR 10/9 for Ex Lap and repair   Drains removed, tolerating diet  Completed course of Zosyn/caspofungin Outpatient follow up with surgery on discharge for staple removal   Delirium Patient oriented x2 10/11 - with worsening mentation throughout the day  CT head 10/11 without pathology  Due to acute illness, opioids  Now resolved Follicular lymphoma with transformation  Follows with Dr. (oncology) s/p chemo, but then lymph node biopsy 6/13/22 showed diffuse aggressive large B cell lymphoma and initiated on R-CHOP chemotherapy, completed 5 cycles, last cycle early Sept Oncology followed, will need continued outpatient follow up   Pancytopenia Due to malignancy/chemotherapy and component of blood loss anemia following surgery  Required repeat PRBCs transfusion on 10/5 and 10/15, 10/16  No evidence of DIC or hemolytic anemia PF4 antibody negative Thrombocytopenia mildly worsening from baseline initially, now stable, and remaining counts are now improving Outpatient follow up with oncology, repeat CBC 1 week   NIDDM2 with hyperglycemia A1c 7.5, on metformin at home Hold home oral meds Hyperglycemia in setting of steroids, on basal/prandial insulin during admission Off of steroids, resume home metformin on discharge   CKD stage II Baseline appears to be around 1.3?1.45 Below baseline, monitor   CAD HLD S/p DES, LHC in 8/4/2021 with mild diffuse LAD disease with stent patent Coninue home ASA, BB and statin    HTN On atenolol, amlodipine, and hydrochlorothiazide at home Hydrochlorothiazide and amlodipine held Had positive orthostatics given poor oral intake, added compression stockings Can resume amlodipine on discharge, continued atenolol Hold resuming hydrochlorothiazide until PCP follow up   Pansinusitis  Incidental on CT head, treated with antibiotics for above Dizziness/lightheadedness Orthostatic hypotension Chronic issue ongoing for a months, occurs with standing and attempting to walk MRI brain showed mild to moderate chronic microvascular ischemia without acute infarct Cortisol level normal Carotid Dopplers negative Orthostatic vital signs positive initially PT/OT with HHC, compression stockings given Will not resume hydrochlorothiazide until outpatient follow up