Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Rash, Rash vesicular, SARS-CoV-2 test negative, Scan with contrast, Ultrasound abdomen normal
Clinical narrative: Patient Name: "PRIVATE", Patient MRN: Unknown. Facility: Local Hospital, Attending Physician: "PRIVATE" MD. Date of Admission: 11/30/2021- Date of Discharge: 12/2/2021. Admission Diagnosis: Abdominal pain, right upper quadrant [R10.11], RUQ pain [R10.11], Herpes zoster without complication [B02.9]. Discharge Diagnosis: Shingles- Discharge Disposition: Home. My date of service is 12/2/21. History (with Chief Complaint) From attending Dr.: "Patient is a 65 y.o. female with UC s/p total colectomy with J pouch c/b multiple SBOs in the past presenting with RUQ pain x3 days. She initially presented to ED 11/30. She has been afebrile with stable VSS. Her labs were normal with normal LFTs, no leukocytosis, Hgb 14.9 -> 10.4 after IVFs. RUQ with no gallstones or cholecystitis. CTAP with dilated loop of terminal ileum/J pouch which may be obstruction at anastomosis, possibly chronic. Surgery consulted and felt patient not clinically obstructed and no indication for surgical intervention. She was admitted for pain control. After >24h, patient still with significant pain getting IV morphine so requested admission to medicine. Of note, patient has had a small painful rash on R abdomen starting on Tuesday so she was also started on Valtrex given c/f shingles. On my evaluation, patient had a small vesicular rash over R abdomen. She notes this started Tuesday. Describes pain in RUQ/R abdomen as sharp, stabbing and intermittent. It is NOT pain similar to her prior episodes of SBO. Pain (prior to morphine was 7-8/10), now 4/10. When she has SBO, she has no PO tolerance and her pain is 10/10. She currently has no n/v. No recent BMs as she has been kept NPO/on clears since 11/30. She states she has been vaccinated against Shingles in 2019. No recent exposures. No new stressors but she works in cancer research so experiences stress day to day. She states on Tuesday there were 3 small areas of redness, now appears to be slightly expanded with vesicles". Brief Hospital Course by Problem: # Zoster: Presented with abdominal pain, with development of classic zoster rash 2-3 days after onset. Vesicular rash associated with electrical pain over single dermatomal distribution. Given abdominal pain and h/o prior surgeries with multiple SBOs, extensive imaging was performed prior to diagnosis of zoster (abdominal ultrasound; CT A/P with contrast), which was unrevealing for alternative etiology of pain. CT A/P was notable for dilated loop of terminal ileum/J-pouch with fecalization of contents. She was evaluated by General Surgery and determined to have no clinical obstruction. She was able to tolerate a regular diet without difficulty. Pain was controlled with oxycodone, Tylenol, and gabapentin. She was started on valacyclovir treatment and discharged to complete a 7 day course. Continue valacyclovir 1000mg Q8h x 7 days total, Take gabapentin 200mg TID while on valacyclovir; may up titrate to 300mg TID as tolerated, short supply oxycodone prescribed. Database was reviewed and consistent with expected prescribing. Discussed keeping lesions covered until crusted over, and provided a note to excuse from work for 7 days.