Age: 79.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Albumin globulin ratio decreased, Angiogram pulmonary abnormal, Aspartate aminotransferase increased, Asthenia, Asthma
Clinical narrative: 1/27/22  80 yr/o female who presents with constant dyspnea for several days associated with productive cough and weakness.  Much worse with minimal exertion.  She was admitted 1/21 - 1/23/22 for covid.  Daughter says she has gotten worse since discharge.  She was vaccinated vs covid X 2 in February, not boosted.  Review of Systems  Constitutional: Positive for fatigue. Negative for fever.  HENT: Negative for sore throat.   Eyes: Negative for visual disturbance.  Respiratory: Positive for cough and shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Negative for vomiting.  Genitourinary: Negative for hematuria.  Skin: Negative for rash.  Neurological: Negative for syncope and Review of Systems  Neurological: Negative for syncope and headaches.  Hematological: Does not bruise/bleed easily.   1/31/22 Hospital Course:    80 year-old female with history of HTN, CKD, hypothyroidism, and liver transplant in 2011 on chronic immunosuppressive therapy and steroids who was admitted and treated for  covid-19 pneumonia  at hospital from 1/21-1/23. She states that she tested positive 1/13. She reports worsening cough, fatigue  and dyspnea on exertion  since discharge.  She was vaccinated x2, not boosted. Her hospital course per problem list is as follows     Cough w subjective sob and dyspnea on exertion  - pulm consulted while here.  -  no hypoxemia noted here  - in setting of recent covid pna. She is 2 weeks out from her initial diagnosis so doubtful this is worsening infection and likely post viral symtpoms.  other ddx include bacterial or fungal pna given immunocompromise (although unlikely with no fever/sputum/leukocytosis) ,  upper airway cough syndrome, asthma, GERD, chronic bronchitis,  reactive airway disease  - CT chest w patchy multilobar pneumonia of the lungs. This is greatest in the upper lobes, cw covid  - eosinophils ok,  BNP WNL  - histo ag's pending , strep ag/ legionella ag neg. Sputum cx insufficient collection.  - echo w EF 57%, mod LVH - treated here with IV solumedrol, 5 days of unasyn and azithro  for possible CAP (although unlikely,) symbicort,   Tussinex,  scheduled nebs, PPI, claritin, prn  tessalon perles and prn  robitussin  - pt's coughing and pulmonary exam improved. No longer w wheezes or crackles. Did well on 6min walk test without evidence of hypoxemia - Plan to dc home w steroid taper, tussinex, tessalon perles, robitussin, claritin, PPI, symbicort, 5 additional days of augmentin. Have also asked CM to see if we can get pt an albuterol nebulizer machine and solution as daughter relays  pt has trouble w  albuterol MDI given memory issues.  2/14/22  PCP Office visit: Pt was recently admitted to the Hospital on 27 January 2021 with shortness of breath.  Patient initially tested positive for Covid on 8 January 2021.  She began to suffer worsening shortness of breath and was seen at the another Hospital ED and admitted for several days.  She slowly improved.  She was discharged home but on 27 January 2022 her shortness of breath worsened.  She presented to ED and was admitted to the hospital with a diagnosis of COVID-19 pneumonia and possible bacterial pneumonia.  Imaging of her chest showed consolidation in the left lobe with patchy bilateral airspace disease suspicious for multifocal pneumonia.  Her clinical picture is complicated the fact that she is immunocompromised due to her liver transplant.  She is on chronic prednisone therapy.  She was seen by pulmonary.  Due to the possibility of bacterial pneumonia patient was started on antibiotic therapy.  She was also treated with IV Solu-Medrol and cough medications.  She improved over the course of several days and was discharged home on 31 January 2021.  She still has occasional shortness of breath and would like a COVID screen to be ruled out for ongoing Covid as well as a follow-up chest x-ray. Review of Systems  Constitutional: Negative for activity change, appetite change and fatigue.  HENT: Negative for congestion, ear pain, nosebleeds, sinus pressure and trouble swallowing.   Eyes: Negative for pain, discharge, redness and itching.  Respiratory: Positive for cough and shortness of breath. Negative for chest tightness and wheezing.   Cardiovascular: Negative for chest pain and leg swelling.  Gastrointestinal: Negative for abdominal distention, abdominal pain, nausea and vomiting.  Endocrine: Negative for cold intolerance, heat intolerance, polydipsia, polyphagia and polyuria.  Genitourinary: Negative for decreased urine volume, difficulty urinating, dyspareunia, dysuria, flank pain, urgency, vaginal bleeding, vaginal discharge and vaginal pain.  Musculoskeletal: Negative for arthralgias, back pain and myalgias.  Skin: Negative for color change and rash.  Neurological: Negative for syncope, weakness, light-headedness and headaches.  Hematological: Negative for adenopathy. Does not bruise/bleed easily.  Psychiatric/Behavioral: Negative for agitation, behavioral problems, decreased concentration, hallucinations, self-injury, sleep disturbance and suicidal ideas. The patient is not nervous/anxious.