Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Bladder catheterisation, Blood culture negative, Blood glucose increased, Blood lactic acid decreased
Clinical narrative: Pt was admitted with a suspected Covid vaccine reaction on 7/14/21 < 48 hrs after her second covid vaccine was received resulting in systemic inflammatory response syndrome resulting in acute encephalopathy, pulmonary edema with small pericardial effusion, high fever, lactic acidosis,  acute respiratory failure and high inflammatory markers.  Pt received her 2nd covid vaccine at 6pm on 7/12 and was in her normal state of heath and was just on vacation a week ago. On 7/13 she complained of being fatigued and went to bed for a nap at 3pm. At 6pm she was witnessed as tremoring all over by family. At 7:45 pm she progressed to severe confusion and EMS was called. She was found hypoxic at 80% on room air. She had a right facial droop and was confused.  Her BP was 159/103, pulse 100, rr 20, glucose 307 Her temp was 100 at the scene.  She went to an ER and her temp was 103.5 with RR 25-30 hr 110 and bp 122/66-161/91 with o2 sats of 89% on 4L. Her cxr showed diffuse pulm edema, CT head neg for acute abnl. Cbc with lymphopenia, hgb 17.8, lactic of 2.2, bnp 367, flu and covid neg. She was transferred to our emergency room and admitted on 7/14/21.  she was noted by her family after waking up from a nap to be confused, lethargic with a right facial droop.  This occurred around 6 PM on the evening of 7/14.  Per the family the patient had received her second dose of the Covid vaccine at 6 PM just the day before.  She had COVID-19 infection back in November 2020.  She underwent work-up in the emergency room and was noted to be encephalopathic and persistently febrile with a temperature of 103 she was tachycardic and tachypneic and hypoxic.  CT of the head was unremarkable chest x-ray showed pulmonary edema there was a question of a urinary tract infection and a Foley catheter was placed.  CT of the brain was negative she was given IV fluids antipyretics and IV Cipro and was transferred to our hospital for further evaluation.  She was treated with Ancef.  She also was given IV Lasix.  The following morning Patient was complaining of severe fatigue and a headache.  Patient's labs were notable for polycythemia which was new with a hemoglobin of 17.1 hematocrit of 53 white blood cell count of 5.76 as well as neutrophilia and lymphopenia of 85% and 7% respectively.  These were new findings compared to her previous CBCs.  She also have an elevated sedimentation rate of 79 a D-dimer of 395 and a high-sensitivity CRP of 38.8.  Patient's lactic acidosis resolved.  By the second day of her hospitalization patient's differential improved with improvement of her lymphopenia and neutropenia and slowly improving polycythemia.  Patient was noted to have hyponatremia of 130 post IV Lasix likely due to poor p.o. intake the day before.  Her urine sodium was 15.  Patient's blood cultures are no growth to date Covid testing was negative.  She has no complaints of dysuria, or frequency.  She did have a CT of the chest which revealed pulmonary edema and trace pericardial effusion.  Patient's echocardiogram done the following day showed resolution of the pericardial effusion and ejection fraction of 70-75%.  She was feeling better and her fatigue improved and her headache is improved and her shortness of breath is back to normal and she denies any shortness of breath and her oxygen saturation is 95% on her normal 3 L and she is felt stable for discharge to home.on 7/15/21