Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Malaise, Myalgia, N-terminal prohormone brain natriuretic peptide normal, Pain in extremity, Productive cough
Clinical narrative: 74F PMHx NSCLC IIIA s/p R upper lobectomy, adjuvant chemo, XRT 2015/2016, COPD w/60 pack-yrs, paroxysmal SVT, RA on chronic corticosteroids, p/w new SOB and productive cough, found to have COVID-19 PNA s/p remdesivir (09/26-09/30), azithromycin (09/26-09/30), and decadron (09/26-10/5).  HPI: 74 yo woman with a history of Non-small-cell lung cancer IIIA status post right upper lobectomy, adjuvant chemotherapy, XRT 2015/2016, COPD with 60 pack-year hx, paroxysmal SVT, RA, who presents with new shortness of breath and productive cough, found in the ED to have COVID19 PNA and a 2L oxygen requirement    She first developed a mild cough and fatigue about 2 weeks ago. She's since then had progressively more productive cough. She had some runny nose last week, and congestion, but feels that her illness is now mostly in her chest. She didn't note loss of taste or smell. Had some runny nose, but that's mostly resolved. This week, her shortness of breath has progressively gotten worse. She is mild SOB at baseline with her lung resection/COPD history, especially with exertion, but this was much more pronounced. No chest pain or lower leg swelling.  She can't walk across the condo without getting SOB. She has had no fevers or chills. She has some muscle aches.    She went to urgent care earlier today, but decided to come in to the ED given that an X ray at urgent care showed PNA and her SOB was worstening. She felt immensely better in the ED after getting placed on O2.    Looking through care everywhere, she had an phone visit with family medicine on 9/20 when she reported about 1 week of sx, so it appears she's been feeling unwell since about 9/13.  Her daughter is not feeling well and was staying with her last week. Her daughter and sister both recently stayed with her. Her sister saw her yesterday. Otherwise she lives alone. She got vaccinated around St Patrick's day for her first Moderna shot, second shot appropriately spaced some weeks later.    Pulmonary history otherwise notable for 60 pack year history- she quit in the 90s, as well as RUL lobectomy as well as XRT for non-small cell lung cancer. She is now in remission.  She takes albuterol now and then for shortness of breath, but no maintenance inhaler.    Also has RA and takes 5 mg prednisone daily for this. Is off Plaquenil.    HOSPITAL COURSE BY PROBLEM (09/26 - 10/5/21)   #COVID19 PNA #NSCLC s/p R upper lobectomy  #Vaccinated COVID #COPD Presented with 2-weeks of productive cough and progressive worsening SOB and DOE, found to have positive PCR for covid (CT 19). She has underlying COPD that is well controlled at baseline, no prior hospitalizations. Chest imaging notable for CTA Chest without PE, but bilateral opacities, most prominent in LLL. Notably WBC is normal at 5 with mild lymphopenia, no fevers at home. Troponin 8 WNL and ntproBNP 71/WNL. Pulmonary history otherwise notable for 60 pack year history (quit >20 yrs ago) and Stage III NSCLC s/p RUL lobectomy and XRT (in remission). 1+ mixed bacteria on respiratory culture, unspeciated. Treated with solumedrol 125 IVx1, remdesivir 5 days (09/25-09/30), decadron 6mg PO x10 days (09/26-10/5). Procal 0.11, however given productive cough + possible COPD history, continued CAP coverage w/ azithromycin for five days.   #Seropositive (RF+), deforming rheumatoid arthritis OP Rheum: MD with Health Authority. On admission reported she felt she was having an active flare. Most pain in bilateral wrists, MCP and PIP. On 5 mg prednisone at home, off plaquenil.