Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Immunodeficiency, Mechanical ventilation, Nausea, SARS-CoV-2 test positive, Staphylococcal infection
Clinical narrative: Hospitalized;  COVID-19 positive (8.29.21);  fully vaccinated. DATE OF ADMISSION:  08/30/2021 DATE OF DISCHARGE:  09/01/2021     PROVISIONAL DIAGNOSES 1. COVID-19 infection. 2. Coagulase-negative staphylococci positive blood culture. 3. Recent status epilepticus with history of childhood epilepsy. 4. Chronic myeloid leukemia, status post allo-HSCT, 10/08/2019. 5. Chronic graft-versus-host disease of skin and eyes. 6. History of lower extremity deep vein thrombosis. 7. Chronic pain. 8. History of pancytopenia. 9. History of attention deficit hyperactivity disorder. 10. History of asthma. DISCHARGE DIAGNOSES 1. COVID-19 infection. 2. Coagulase-negative staphylococci positive blood culture, suspected contaminant. 3. Recent status epilepticus with history of childhood epilepsy. 4. Chronic myeloid leukemia, status post allotransplant in October 2019. 5. Chronic graft-versus-host disease of the skin and eyes. 6. History of left lower extremity deep vein thrombosis. 7. Chronic pain. 8. History of pancytopenia with normocytic anemia. 9. History of attention deficit hyperactivity disorder. 10. History of asthma. CONDITION ON DISCHARGE Stable. PROCEDURES PERFORMED None. CONSULTATIONS 1. Bone Marrow Transplant team. 2. Infectious Disease   HOSPITAL COURSE The patient is a very pleasant 28-year-old male with past medical history as listed above including history of CML, status post allo stem cell transplant in October 2019; graft-versus-host disease; recent status epilepticus requiring ventilator for airway protection; and now newly diagnosed COVID-19, who presents to Emergency Department secondary to worsening symptoms.  The patient was seen in the Emergency Department on August 29 with symptoms of fatigue, nausea, vomiting, and cough.  COVID-19 was positive at that time.  Blood cultures were obtained.  The patient was discharged home.  He returned the following day with worsening symptoms.  It was also noted that a single blood culture was positive for coag-negative staph.  With the COVID positivity, the patient did receive Regeneron antibodies on August 29.  Dex was not started as the patient was not hypoxic.  He was medically stable with stable vital signs and was admitted and started on IV fluid hydration.  Blood cultures were redrawn and he was started on empiric vancomycin.  The coagulase-negative staph positive blood culture was felt likely to represent contamination, but in the setting of immunocompromised state and COVID infection, Infectious Disease was consulted.  They agreed this was likely contaminant.  Oral vancomycin was discontinued.  Repeat blood cultures remained negative at 48 hours.  ID recommended starting remdesivir on 08/31 given he was less than 7 days into symptoms and his cycle threshold is on the lower side.  Chest x-ray was obtained and was negative for acute process.  The patient remained very stable and had clinical improvement and was felt medically stable for discharge on 09/01/2021.  He will receive a second dose of remdesivir prior to discharge.  Given immunocompromised state, the patient may discontinue quarantine respiratory isolation on September 15.  The Bone Marrow Transplant team was consulted and will arrange outpatient followup.