Age: 74.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Blood iron, Blood thyroid stimulating hormone decreased, COVID-19, Confusional state, Dyspnoea exertional
Clinical narrative: Patient is 75-year-old female who per patient presents to the ER complaining increasing fatigue over the past 2-3 days that she feels weak and short of breath when she walks across the room.  She has not felt well so she is not taking her medications for the past couple days.  She denies any fever or chills or nausea or vomiting or diarrhea hand or headache.  Patient reports she had COVID-19 in January this year is unvaccinated.  She is followed by Dr. rheumatology clinic for p-ANCA vasculitis. Dr. in ED discussed the case with another doctor.  Patient was  treated as an outpatient for possible bacterial pneumonia on 04/11 with Omnicef.  Patient patient reports that about 7 days ago she was in the ED for "confusion weakness and had COVID testing the 1st 1 was positive the 2nd was negative the 3rd was positive and the 4th was negative this is all per family.  The patient and family decided she did not have COVID and she is not taking specific precautions. Currently patient is wearing O2 at 2 L in room; family reported that she wears O2 since covid in January but she tells me she didn't wear it last night since her electricity was off during the night due to a thunderstorm.  DISCHARGE:   1. CAP (community acquired pneumonia), Discharge, 05/03/2022  2. 2019 novel coronavirus disease (COVID-19), Discharge, 05/03/2022  with post-COVID BOOP/organizing pneumonia  3. ANCA-positive vasculitis, Discharge, 05/03/2022  4. Chronic hypoxemic respiratory failure, Discharge, 05/03/2022  5. Anemia, Discharge, 05/03/2022  6. Hyponatremia, Discharge, 05/03/2022  Secondary Diagnosis and Comorbidities:   Hospital Course       Admitted with Acute on Chronic hypoxic respiratory failure now at her 2 L baseline With her history of vasculitis and immunosuppression, empirically on broad spectrum antibiotics for bacterial pneumonia with her patchy infiltrates. She is COVID positive both here and about 3 days ago. She had COVID in January but I'm not sure this is srtill positive from that infection. She likely does not mount much of an antibody response due to rituxan so it's reasonable to think she has been exposed and got COVID again, albeit hopefully a milder variant and some immune response - this may be what we see in her lungs but reason she is on baseline O2 requirements. With her complete acute onset fatigue and patchy infiltrates this could represent COVID-19 viral pneumonia. She takes prednisone at home for vasculitis is skipped last 2-3 day doses. Gave her stress dose of steroids with Solu-Medrol 80 IV once now on prednisone 40mg a day. Her inflammatory markers are up not unexpectedly with her vasculitis, so unlikely to benefit from redosing Rituxan. Spoke with Drs (Rheum) and (Pulm) both see her outpatient - assistance much appreciated    Hyponatremia: mild, stress dose steroids as noted above. Recheck am same to better TSH <0.2 - added free T3,4 and both within normal ranges.    Chronic normocytic anemia: stable, but down further here, then back up day of discharge - needed transfusion outpatient recently  Got iron studies, looks like she is adequately replaced, consistent anemia of chronic disease