Age: 23.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase increased, Arteriogram coronary normal, Arthralgia, Aspartate aminotransferase increased, Blood creatine normal
Clinical narrative: 1/11/21 COVID Pfizer vaccine #1 = no issues (given at Clinic = screening form marked all no but had a 30 min watch post vaccine 1/29/21 Covid Pfizer vaccine #2 EL0261 left arm at Clinic, 2/20/2021: medical sent to local ER on 2/20 for 2 day c/o worsening left hand/forearm numbness, coldness, discoloration to left hand and pain (purple appearance). Was seen at clinic with negative DVT r/o US, nl imaging and labs. 2/21 sent to ER c/o UE pain and weakness x 5 days (woke up with bicep pain that progressed to numbness, tingling, swelling and discoloration of hand (cyanosis pallor and cold LUE x 3 days). Severity is moderate. Quality dull pain. Currently invo 1/11/21 COVID Pfizer vaccine #1 = no issues (given at Clinic = screening form marked all no but had a 30 min watch post vaccine  1/29/21 Covid Pfizer vaccine #2 EL0261 left arm at Clinic - no c/o reported 2/20/2021: medical sent to local ER on 2/20 for 2 day c/o worsening left hand/forearm numbness, coldness, discoloration to left hand and pain (purple appearance). Was seen at clinic with negative DVT r/o US, nl imaging and labs.  2/21 sent to ER c/o UE pain and weakness x 5 days (woke up with bicep pain that progressed to numbness, tingling, swelling and discoloration of hand (cyanosis pallor and cold LUE x 3 days). Severity is moderate. Quality dull pain. Currently involves entire left arm (arm, elbow forearm wrist hand).. Did have some swelling and motor loss, NO CP, SOB or sensory loss, no redness, no injury, no fever, chills, ha, depression sore throat, cough, rash, lymphadenopathy, abd pain, GI distress, no trauma or recent illnesses. 2/21: admitted clinic w/rhabdomyolysis: no preceding workouts, increased activity on ship, back sleeper, no alcohol, no trauma,. nsp: skin intact, no erythema. Mild edema to upper arm around triceps. Mild purple discoloration to dorsum of hand. Palp: TTP about triceps. TTP anterior shoulder. TTP biceps. Able to palpate triceps tendon and biceps tendon. NTTP throughout the rest of hand and forearm. Hand is cooler relative to contralateral side. NTTP cervical spine. ROM: Full passive ROM of the shoulder and elbow with pain. No micromotion pain with any joint in the upper extremity. Painless cervical spine ROM. Motor: 3/5 strength to OP/FPL/2nd FDP, EIP/EPL, 1st and 2nd DIO. 3/5 deltoid, biceps, triceps, wrist extensors, wrist flexors. Sens: Decreased sensation throughout entirety of forearm and hand distal to the elbow. Above the elbow, sensation is intact. Vasc: 2+ radial pulse, symmetric to contralateral side. BCR <3 sec. Hand is cooler than contralateral side. Lab: CRP <5, ESR 4, CK 31,924, PT 14, INR 1.1, D-dimer 0.46, AST 610, ALT 186, Cr 0.94, WBC 6.3 Imaging: Radiographs of the chest, shoulder, elbow, wrist, and hand demonstrate no fracture. The shoulder is well located. CTA starting at the heart demonstrate no vascular abnormalities. Assessment: unlikely that he has compartment syndrome or a cervical spine pathology. His exam does not localize to one specific innervation or muscle group. His paresthesias and diffuse 3/5 weakness on exam may be related to parsonage turner syndrome (post viral neuritis) versus edema. While he does have a cool hand and mild/moderate edema on exam, his CTA is normal and his exam is very reassuring that this is not compartment syndrome. He likely has rhabdomyolysis based on upper arm swelling in the setting of CK of 31924.   Discharge 2/22/2021: He received a total of 3 liters of IV fluids and was encouraged to drink large amounts of water. Repeat CK levels showed to be down trending as were his AST and ALT enzymes. Plain radiographs of his left arm and shoulder were unremarkable as was CT angiography of his chest. Electrolytes and renal lab work was within normal limits throughout the hospitalization.On the day of discharge, he was tolerating a PO diet, ambulating without difficulty, and hemodynamically stable. LUE w/ minimal swelling, no erythema. TTP over L triceps belly, No TTP over the distal LUE. Somewhat decreased sensation to light touch over distal LUE. 2+ radial pulses b/l. LUE ROM somewhat limited 2/2 pain, but intact. ---- to f/u with HCP in 2 weeks, sooner if worse (medical officer)   CK 2/22/21 was down to 14653