Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Antimitochondrial antibody normal, Antineutrophil cytoplasmic antibody negative, Antinuclear antibody negative, Bilirubinuria, Biopsy small intestine
Clinical narrative: 56-year-old very pleasant female with a known history of alcohol dependence and cirrhosis along with tobacco dependence and underlying nonoxygen dependent COPD who presented to the ER on 6/16 with uncontrolled diarrhea that started suddenly 2 weeks after getting her johnson and johnson vaccine on 5/5/21 associated with significant weight loss and persistent nausea and acute renal failure.  She initially presented to her PCP on 5/25 complaining of urinary urgency for the past few months.  She denied any frequency or dysuria but reported that her urine had an odor and an orange color.  During that visit urine was positive for nitrates and leukocyte esterase she also had bilirubin in her urine and was given a 7-day course of Macrobid.  There was not enough urine to send to the lab for culture.  She then went to the emergency room that evening because her PCP contacted her that her potassium was low and she was sent to the emergency room during that visit she reported developing diarrhea she was given potassium and discharged home.  She followed up with her PCP on 6/1 to follow-up on her ER visit and reported that the antibiotic was helping her urinary tract infection she continued to complain of some urinary urgency and it was recommended she have a urine culture done again which showed pansensitive E. coli which despite being sensitive to Macrobid she did not respond so she was prescribed 5 more days of Cipro.  She reported that she quit drinking alcohol on 5/19/21 but admitted to drinking a beer now and then.  Patient had her Johnson & Johnson COVID-19 vaccination on 5/5 and reports she was tired for a day or 2 afterwards and then felt better but then 2 weeks thereafter she felt terrible with associated development of nausea, weight loss, new diarrhea which has continued to progress to developing significant diarrhea and weight loss and fatigue  for which she presented back to the ER on 6/16 with acute renal failure, uncontrolled diarrhea, hyponatremia and hypokalemia and metabolic acidosis. Imaging showed pancolitis, colonoscopy performed show diffuse bowel wall edema. She remains hospitalized as of 6/23/21.    Stool pathogens panel and stool C. difficile x2 are both negative but the diarrhea is persistent and severe.  Pt reports gi symptoms bagan 2 weeks after receiving her J and J vaccine associated with nausea, abd pain and development of diarrhea.  CT of the abdomen pelvis showed a pan colitis and enteritis. colonoscopy was normal other than showing sign mucosal edema. Pathology negative for malignancy but the terminal ileum shows prominent peyers patches which are the immune sensors of the intestine..  stool o and P neg. Lactoferrin/fecal leukocytes is neg.  fecal fat pending. stool ob neg.  esr and crp markedly elevated.-  budesonide 9mg was started, Added imodium q6h and acidophilous qid. rheumatoid factor neg, antinuclear and antimitochondrial antibodies neg, antineutrophilic cytoplasmic antibodies neg, anti-Saccharomyces cerevisiae antibodies neg and antithyroid peroxidase antibodies neg ,celiac ds panel neg. stool ob neg.. renal failure is felt due to acute tubular necrosis from severe diarrhea and poor po intake. She remains hospitalized in serious condition as of 6/23/21.