Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Antineutrophil cytoplasmic antibody, Asthenia, Back pain, Blood test, Bronchoscopy
Clinical narrative: /22 second Covid Moderna Vaccine  4/23 high fever 103.4, aches chills 4/24 - weak, achy, low grade fever around 100 4/25- 4/30 low grade fever around 100, night sweats, congestion, sinus drainage, back pain on left upper side 4/30  negative Covid Test 5/5 blood draw 5/7 NP visit, nothing unusual with lungs,  5/10 chest xray  5/12 Pulmunogsit reviewed Xray and put me on Levaquine and 10 days 5/17 Chest CT w/o contrast 5/19 steroids presribed - fatigue, night sweats and fevers continuing  6/4 same symptoms, called Dr - new scrip for prednisone (took 5mg/day) 6/10 Visit with NP,  recommend I see Dr; blood work ordered 6/16 pulmonary function  6/18 Pet scan 6/21 Dr ordered more diagnostic tests  6/30 Broncoscopy and blood tests ordered  7/1 CT w/ contrast of sinus, no issues 7/8 Dr visit, lab results inclusive for Wagerers, more blood tests (?) and ordered lung needle biopsy 7/20 CT scan showed so much improvement that   needle Biopsy was not done.  8/18 Chest CT  8/19 Possible vasculitis .   *** what follows is the report from Dr ***  Progress Notes Encounter Date: 8/19/2021    History of Present Illness:  The patient is a 67 y.o. female, for follow-up, and is here for pulmonary review. HPI The patient has undergone extensive evaluation for bilateral pulmonary infiltrates occurring in the setting of a febrile illness around May 2021. Her symptoms occurred shortly after receiving COVID Moderna vaccination, 2nd dose and she believes there is a temporal and causal relationship.   This occurs in the setting of previous bronchiectasis and concerns for atypical mycobacterial infection.    She had extensive infiltrates bilaterally on CT imaging in May 2021. She underwent bronchoscopy which was not diagnostic and specifically cultures were negative for acid-fast bacteria, not yet finalized, negative for fungus, finalized, without diagnostic cytologic material.    Interestingly anti neutrophilic cytoplasmic antibody is negative. Other allergy immune status testing is all negative.   Patient was offered needle aspiration of pulmonary infiltrates which had improved last month and interventional radiology performed needle aspiration was declined by the treating radiologist.   More recently CT imaging of the chest is once again repeated and on current films there remains remarkable improvement in pulmonary infiltrates but not yet total resolution.    Patient was told that we think it is most likely that she may have a systemic vasculitis which has resolved likely somewhat spontaneously. We cannot rule out a possible pulmonary infection with improvement but nevertheless ANCA is positive.    We offered repeat ANCA today and she wishes to decline. We offered Rheumatology evaluation today and she wishes to decline.    She offers that she feels well. She denies fevers chills and sweats. She has nose significant shortness of breath. She has had no hemoptysis or other systemic symptomatology.    Pulmonary function testing is within normal limits including forced vital capacity and FEV1 and expiratory flow rates and lung volumes and diffusing capacity.   IMPRESSION: Chest CT August 2021  *  Decreased bilateral consolidation suggestive of resolving atypical multifocal pneumonia and/or developing scarring.  CT follow-up is recommended to evaluate for complete resolution and exclude underlying or occult process. *  Unchanged mediastinal lymph node enlargement which may be reactive or inflammatory. *  Unchanged mild central and lower lung bronchiectasis.   Approved by Resident: 8/18/2021 2:55 PM  I have personally reviewed the image(s) and agree with and/or edited the report  Finalized by MD on 8/19/2021 9:27 AM   Physical Exam:   BP 130/80 (BP Site: Right Arm, BP Postition: Sitting) | Pulse 78 | Ht 162.6 cm (5' 4") | Wt 72.6 kg (160 lb) | SpO2 97% | BMI 27.46 kg/m²   Physical Exam Vitals and nursing note reviewed.  HENT:  Head: Normocephalic.  Nose: Nose normal.  Mouth/Throat:  Mouth: Mucous membranes are moist.  Eyes:  Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:  Rate and Rhythm: Normal rate.  Pulmonary:  Effort: Pulmonary effort is normal.  Breath sounds: Normal breath sounds.  Abdominal:  General: Abdomen is flat.  Musculoskeletal:  General: Normal range of motion.  Cervical back: Normal range of motion.  Skin: General: Skin is warm.  Neurological:  General: No focal deficit present.  Mental Status: She is alert.  Psychiatric:  Mood and Affect: Mood normal.    Assessment and Plan:  Bilateral pulmonary infiltrates, improved, not totally resolved Positive anti neutrophilic cytoplasmic antibody History bronchiectasis    Plan We believe ANCA related vasculitis may be present Offered repeat ANCA and Rheumatology evaluation both declined by patient at this time Repeat chest CT in 6 months then return visit flow volume loop DLCO Patient is convinced that pulmonary illness may be related to Moderna vaccination. We believe it is therefore reasonable to have her next booster for COVID performed with different vaccine such as Pfizer or Johnson & Johnson.  MD