Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Anion gap, Asthenia, Blood chloride decreased, Blood creatinine increased, Blood potassium decreased
Clinical narrative: Pfizer Dose 1 3/14/21 (EN6204) Pfizer Dose 2 4/7/21 (ER8737) COVID Positive 12/30/21  12/30/21: Patient is a 63-year-old female with a past medical history significant for obesity, anxiety, GERD, fibromyalgia, hypertension, OSA, suspicious vertebral metastatic lesions noted on MRI of lumbar spine was no known primary lesions noted.  Patient presents to the ED today with complaints of generalized body aches and significant fatigue that has been ongoing over the last 4-5 days.  The patient states she has been experiencing worsening musculoskeletal pain since August 2021. The patient subsequently had an MRI that revealed suspicious vertebral metastatic lesions in her lumbar spine with no known primary lesion or origination.  The patient underwent CT chest and CT abdomen/pelvis which revealed no other abnormalities or lesions.  Patient was instructed to have mammogram, colonoscopy and was scheduled to have PET scan completed as an outpatient once discharged from the hospital on December 21, 2021, however the patient states she has been feeling unwell and has not had any of these completed or scheduled.  The patient does admit that the last 4-5 days her symptoms have significantly worsened, stating that her fatigue has been so severe she is unable to poor herself a cup of coffee without feeling as if she needs to take a break.  Upon arrival to ED today patient tested positive for COVID-19 infection.  The patient denies any fever, chills, cough, shortness of breath, chest pain. The patient admits to dizziness, weakness, fatigue, body aches, worsening musculoskeletal pain, nausea without vomiting, decreased appetite.  Of note, the patient states she has lost 50 lb over the last 6 months due to decreased appetite.  The patient is vaccinated against COVID-19.  The patient denies any alcohol abuse, illicit drug abuse or tobacco use.   Upon arrival to ED patient's temperature is 96.9°, heart rate 82, respirations 18, pulse ox 95% on room air, blood pressure 97/68.  Chest x-ray reveals unremarkable chest. CT head reveals no evidence of intracranial metastatic disease or other acute findings, MRI would be more sensitive for small lesions.  Patient's laboratory findings are significant for potassium 2.9, chloride 94, a gap 17, creatinine 1.12, WBC 3.18.  The patient received 50 mcg IV fentanyl, 4 mg IV Zofran, 20 mEq IV potassium chloride 40 mEq p.o. potassium, 1 L IV normal saline in ED.  1/3/22: 63-year-old woman recently diagnosed with metastatic vertebral lesions with unknown primary who presented worsening generalized myalgias, bone pains and fatigue.  In the emergency department COVID-19 PCR subsequently came positive.  She was admitted to the hospitalist service of Pain Management and further workup.  Pain management also optimized with IV zoledronic acid x1, oral Decadron and narcotics with good effect.  Oncology was consulted, further labs were sent for evaluation of cytopenia and metastatic bone lesions per Oncology recommendations.  She was planned for CT-guided bone marrow biopsy this a.m. however this was declined by Interventional Radiology, recommended to get diagnostic testing as an outpatient following COVID recovery.  She has been discharged today in stable medical condition to continue outpatient follow-up.