Age: 67.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Interstitial lung disease, Malaise, Muscle spasms, Musculoskeletal chest pain, Nausea
Clinical narrative: Hospitalized 01/26/2022; COVID-19 positive 01/26/2022; fully vaccinated  Discharge Provider: MD Primary Care Provider: MD Admission Date: 1/26/2022 Discharge Date: 02/02/2022 PRESENTING PROBLEM: Chest wall pain COVID-19  Respiratory distress    HOSPITAL COURSE: The patient is a 67-year-old lady was presented to the hospital with worsening shortness of breath and chest pain.  She is on chronic home oxygen at 2.5 L.  She apparently became sick approximately 11 days ago while out of state and tested positive for COVID on January 15. She came to HCF as she was not able to get the antibody infusion.  Her symptoms 10 days ago year included fever with significant body ache with progressively worsening dyspnea and desaturations with activity along with the fatigue and poor appetite with loss of taste and nausea.  She called her physician she was recommended to go to the emergency department.  She developed a left-sided chest discomfort described as sharp constant pain worse with deep breath no radiation or specific relieving or aggravating factors except worsening with deep breaths.  This has been going on for about 3 days.  Denies any palpitations or any swelling in the legs during this time the patient did complain was getting more fatigued and having some dizziness and having to sleep more.  The patient stated that her baseline she is very active and the travels all the time.  The patient also gave history of suprapubic cramping and was diagnosed with urinary tract infection while out of state for which she received an antibiotic she was subsequently switched to Bactrim as the earlier antibiotic did not help her.  The patient the is followed up with the pulmonary hypertension clinic and was last seen in October where she was noted to have increased crackles the secondary to her underlying interstitial lung disease which is related to rheumatoid arthritis.  Follow-up echo at that time showed the vent right ventricular systolic pressure of 37 with mild aortic stenosis.  The patient presented to the local emergency department where she was found to be extremely dyspneic even with minimal exertion.  Sats were going down to mid 80. A CT scan of the chest was done which did not show pulmonary embolism but showed worsening interstitial changes.  She was seen by Pulmonary and started on IV steroids due to history of a LD.  Cultures were done were all found to be negative.  Antibiotics were subsequently stopped.  The patient continued to improve and was down to 2 L per nasal cannula.  The patient's white count were found to be low likely secondary to mycophenolate.  She was given an injection of Neupogen which bumped of the white counts.     The patient was back to her baseline of 2 L by nasal cannula and required 3L with activity, and was subsequently discharged home.     Because pt does not tolerate prednisone, she was discharged on tapering dose of Solumedrol as per med rec.   The patient is due for her 3rd short of COVID vaccine.  She was recommended to follow with the primary care physician in a month for the booster vaccination.     She was discharged home on February 2nd with 3 L nasal cannula with activity, 2 L nasal cannula at rest. She was also discharged with doxycycline to complete a total of 10d treatment.  The patient's Cellcept was held during this admission for recommended 4 weeks, it is recommended pt follow up with her Rheumatologist in order to resume.