Age: 82.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Head injury, Hodgkin's disease, Liver function test normal, Lymphadenopathy, Pain
Clinical narrative: ADMISSION: - Patient is an 82 yo male w/ PMH of afib (pacemaker), CAD, HLD, HTN, HOH, CHF.   He is known to Dr. and currently on Keytruda for his hodgekin's lymphoma.  He was originally diagnosed 12/2019 when he presented with extensive L sided cervical adenopathy along with L supraclavicular, L subpectoral, retroperitoneal, and multiple aortocaval LAD.  He had a LN bx 1/22/20 and path revealed classical hodgkin's lymphoma.  In 2/2020 he was started on the clinical trial with Brentuximab and Vedotin.  He improved and continued on this for 16 cycles (last 2/22/21).  He had restaging scans on 3/2021 which revealed overal increase in LAD in his neck as well as abdomen and pelvis. He was started on Keytruda 3/25/21.  Since then he has completed 12 cycles of Q3wk Keytruda, the last treatment on 12/15/21.  He has done well on this treatment and has not had any e/o IO toxicity. Restaging scans 11/2021 showed e/o a known fall but, otherwise restaging scans and counts were stable.  Patient presented to the ER overnight (1/4) w/ chief complaint of SOB and some "confusion."   He tested positive for COVID.  He was started on Remdesivir and Dex.  ER w/u revealed pancytopenia, not neutropenic and no transfusions indicated. Lytes, cr, and LFTs were stable.  CXR consistent with COVID.  No e/o sepsis.  Lactic acid, PCT, and troponins all normal.  He was admitted to the COVID unit for further observation and care. His o2 was 88-87%, he was placed on 2L of o2.  Talked to his daughter this morning who was able to give me more of a hx.  Unfortunately her husband passed away suddenly a week and a half ago or so and the funeral was 12/30.  She reports that there have been several people who have reached out to her confirming they had a positive COVID test.  She herself does not have a known covid diagnosis.  Patient did not go to the funeral but he did have exposure to some individuals who did and who have since tested positive.  He is vaccinated. He has had noted increase weakness for some time but the worsening cough, congestion, and SOB has gotten exponentially worse over the past week per his daughters report.  She also tells me that he fell last friday and she thought he may have hit his head.  She reports he lost his balance, tripped over his feet, and she thinks he hit his head on the buffet.  The confusion seemed to get worse after this as well.  He did not come into get evaluated after this fall.  On patients scans in November he was noted to have a L nondisplaced ischial tuberosity fracture.  Although it has caused him some pain, he has still been able to get up and use his walker since this was diagnosed.  He has not seen ortho.  He was also noted to have a new focus of FDG uptake involving the T4-T5 vertebral bodies and underlying lymphomatous involvement cannot be excluded.  He had a fall prior to those scans so this was being monitored.  May consider MRI as an outpatient.  This morning patient reported that he felt better.  He is extremely hard of hearing so it was difficult to tell what was confusion/slow response v difficulty hearing.  He was able to tell me his name, dob, year, building and city, as well as the president.  He was somewhat slow in his response.  He denied any HA or vision changes.  No BM x2 days.  No specific areas of pain.  He does use o2 occasionally at home.  This was also confirmed by his daughter.  She said that he does not wear it like he should though.      PT IS CURRENT INPATIENT, NO DISCHARGE AT THIS TIME.