Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Fibrin D dimer decreased, Flank pain, Glomerular filtration rate decreased, Gout, Haematocrit normal
Clinical narrative: 66 Y male with HTN, hyperlipidemia, CKD bl scr 1.3-1.5, diet controlled DM2, afib on pradaxa, h/o MCA CVA c/b ICH 1/2019, pericardial effusion 2019 attributed to volume overload, improved on f/u TTEs, OSA on CPAP, vaccinated for COVID.  Pt had onset of fever, cough on 9/8, tested positive for COVID 9/9.  Pt presented to ED 9/13/21 ongoing sx of fevers, cough, body aches, rhinorrhea, diarrhea along with new dysuria and right LBP concerning for additional GU pathology and advised to come to ED for work up.     In the ED, temp 100.3 and patient noted to be tachypnic, O2 sat 96-99% on RA. EKG with NSR, poor R wave progression (similar to prior), no significant ST/T changes. Labs significant for Na 128, Cr 1.58, troponin 0.11, and CRP 5.4. UA negative.  CXR with diffuse increased interstitial lung markings involving bilateral lower lobe. CT abdomen/pelvis with no discrete renal or ureteric calculus, no hydronephrosis or hydroureter. Pt was admitted for troponin elevation, r/o ACS.     COVID treatment was started following day on 9/14 when pt desaturated with ambulation.  After admission pt also reported right perianal pain and was found to have R perianal abscess, s/p bedside I&D per general surgery team.   Troponin elevation, HTN, hyperlipidemia - trop peaked at 0.14-- >0.12, no associated CP or ischemic EKG changes.  Suspect demand ischemia related to COVID infection -cont PTA coreg, ezetimibe, fish oil -held losartan 9/15 due to slight increase in scr, scr back to baseline 9/16 after encouraged PO intake.  On discharge, resumed losartan at half dose 50mg daily.  RN to recheck chem 7 on 9/18/21  -held pta hctz due to hyponatremia, cont to hold on DC.  If PO intake, Na, scr stable, can be resumed per PCP -Pt already anticoagulated with pradaxa -given multiple risk factors for CAD, consider stress test for further risk stratification once recovered from covid and completed isolation.   COVID-19 pneumonia with acute hypoxemic respiratory - Symptom onset on 9/8. COVID positive on 9/9. Last fever on 9/13.  Desaturated with ambulation on 9/14, placed on 2 liters O2 and started on treatment with Remdesivir and Decadron.  Pt received Remdesivir and decadron for 3 days, stopped on discharge as pt was able to wean off oxygen completely.   -cont isolation 20 days from onset of sx, through 9/28, can come off isolation 9/29 if no fever >24 hrs off antipyretics and other s/sx covid much improved   Right low back pain - pt denied dysuria on admission, but report mild R low back pain which improved throughout hospitalization, suspect musculoskeletal pain related to covid infection.  As above CT a/p in ED was unremarkable for any acute findings, UA not s/o infection.  On day of discharge, pt reported a twinge of pain with urination one time, a repeat UA was checked which remained negative.  No further pain with subsequent urinations.  Pt was prescribed lidoderm patch tid prn to right low back.     Right perianal abscess - after admission pt reported having pain and feeling a bump in R perianal region.  Pt was found to have a 1 cm, perianal abscess.  Appreciate gsurg consult, s/p bedside I&D 9/14 with 10 mls of pus evacuated.   Per General surg recs: -cont wound care /packing bid.  Son taught how to do per nursing.  Referral also sent for RN to f/u and reinforce packing / dressing change bid -zosyn (9/14-9/16), transitioned to augmentin on DC to complete total 7 day course of abx -sitz baths tid and with each BM, warm compress to area for pain control -Econsult sent to general surgery clinic for f/u with pt after pt completes COVID isolation   AKI on CKD - baseline scr 1.3-1.5, scr up to 1.68 9/15.  Suspect prerenal with covid infection. No s/sx fluid overload on exam, bnp low on admission.  Scr back to baseline with holding losartan and pushing po fluids -on DC, resumed losartan at half home dose 50mg daily, RN to recheck chem 7 on 9/18 -hold hctz for now   1 of 2 bcx 9/13 with coag negative Staph (Staph hominis) - contaminant, no further evaluation indicated.     OSA - cont home cpap qhs   DM2 - on diet control PTA, minimal fsbg elevation while on decadron treated with SSI in hospital   ATRIAL FIBRILLATION, PAROXYSMAL - no acute issues.  cont PTA coreg, pradaxa   GOUT - no acute issues.  Cont pta allopurinol  HX OF ISCHEMIC STROKE - no significant residual deficits per pt.   -cont PTA pradaxa, ezetimibe, fish oil, antiHTN as above     Procedures:  Bedside I&D of right perianal abscess     Reason for Hospital Admission (Admitting Diagnosis):  Troponin elevation due to demand ischemia COVID 19 pneumonia with acute hypoxemic respiratory failure Right perianal abscess   Complications: none   Consults:  General surgery