Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral atrophy, Cerebral small vessel ischaemic disease, Chemotherapy, Chest X-ray abnormal, Chronic sinusitis
Clinical narrative: DATE OF ADMISSION:  05/30/2022 DATE OF DISCHARGE:  06/03/2022   ATTENDING:  MD ADMISSION DIAGNOSES 1. Left lower lobe pulmonary emboli. 2. Acute hypoxic respiratory failure, COVID-19 positive. 3. Anemia. 4. Subdural hematoma with history of severe left frontal headaches and subdural hygroma with mild mass effect and slight right midline shift. 5. Burkitt's lymphoma with bone marrow involvement. 6. Recent acute sigmoid diverticulitis. 7. Cancer-related pain, abdominal pain with chronic back pain. 8. History of oropharyngeal phase dysphagia. 9. Coronary artery disease and hyperlipidemia. 10. Gastroesophageal reflux disease. 11. History of prostate cancer. 12. History of renal cell cancer. 13. History of abdominal aortic aneurysm without rupture.   HOSPITAL COURSE The patient is an 80-year-old male with past medical history for recent diverticulitis, Burkitt's lymphoma.  He recently finished cycle 1 of DA-R-EPOCH on 05/21/2022 and received Nyvepria.  He was recently admitted for diverticulitis and discharged home on Levaquin.  The patient presented to the emergency department with complaints of abdominal pain, hypoxia, and hypotension.  The patient had CT abdomen and pelvis which showed left lower lobe pulmonary emboli, stable appearance of the sigmoid colon.  Lab work was significant for lactic acid of 3.5, hemoglobin of 6.9.  In the emergency department, the patient had on and off confusion.  He reported abdominal pain at 7/10.  Pain now worsened with eating, but he stated he had not been eating much.  He also has been short of breath.  The patient reports having blood in his stool, but states it had been approximately 7-10 days.  The patient received approximately 2.5 L of IV fluids in the emergency department as well as red blood cells.  The patient was also found to be COVID positive.  However, despite fluid resuscitation, the patient continued to be hypotensive, and the patient was admitted to the medical ICU on Levophed.  The patient was found to have lower extremity ultrasound positive for peroneal DVT.  The patient was started on Decadron for COVID-19 pneumonia.  CT of the thorax did show a left lower lobe segmental pulmonary emboli.  Echocardiogram showed ejection fraction of 64% with normal size and function of the right ventricle.  Neurosurgery was consulted for anticoagulation recommendations.  Anticoagulation was held in the setting of a subdural hematoma and thrombocytopenia.  IR was consulted for IVC filter placement.  The patient was started on broad-spectrum antibiotics for shock.  Lactic acid did improve.  Once patient had stabilized, he transferred back to the Oncology Service.  Neurosurgery recommended keeping the patient's platelets above 75,000.  The patient did develop intermittent word-finding difficulty during hospitalization and Neurology was consulted.  Brain MRI showed stable very thin left cerebral convexity subdural fluid collection, approximately 3 mm in maximal thickness.  No significant mass effect.  EEG showed intermittent left temporal slowing, generalized rhythmic delta activity, mild-to-moderate diffuse slowing and disorganization.  No epileptiform discharges or electrographic seizures.  The patient had IVC filter placed per Interventional Radiology.  The patient's antibiotics were discontinued as the patient had adequately been treated for diverticulitis and shock had resolved.  The patient was continued on steroids for his COVID pneumonia.  As the patient was stable, plans were made to discharge the patient to home.  This was discussed with Neurology prior to discharge.  We will continue dexamethasone to complete course.  The patient's chemotherapy will be pushed back by 1 week with outpatient followup