Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Anaemia, Ankle fracture, Anticoagulant therapy, Bedridden, Biopsy
Clinical narrative: Blood counts prior to that date: always perfect March 31, 2021 1st dose Pfizer COMIRNATY vaccine 01 April 2021 I start vomiting: over 3 mouthfuls of food everything is vomited April 21, 2021 2nd dose Pfizer COMIRNATY vaccine April 21-23, 2021 fever 39.5 ° C-40 ° C and uninterrupted epistaxis April 29, 2021 personal malleolus fracture May 02, 2021 hospital for foot plaster and start of heparin May 05, 2021 CBC: thrombocytopenia, Hb 11.4 g / dL, CRP 3 mg / dL May 11, 2021 orthopedic discontinue heparin and start fondaparinux 2.5 mg 1 fl. He said "surely it's all due to the vaccine."  May 12, 2021 CBC: thrombocytopenia, Hb 11.1 g / dL, RBC 3.89x106 mcL. request for "heparin dependent PF4 antibodies" test May 14, 2021 CBC: thrombocytopenia May 17, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, RBC 3.77x106 mcL, HCT 32.7%. "heparin-dependent PF4 antibodies" test has been suspended throughout: perhaps because it is the only test that would have admitted the correlation between the covid19 vaccine and thrombocytopenia and splenomegaly? May 26, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, reactive lymphocytes present May 28, 2021 haematologist "it is possible (but not demonstrable) that the induction of thrombocytopenia is linked to the 2nd dose of the anti SarsCoV2 (Pfizer) vaccine ... Important epistaxis and bruising on the whole body are reported from the 2nd / 3rd day post vaccination, which suggests thrombocytopenia prior to trauma and LMWH therapy. " May 31, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, HCT 33.5%, RBC 3.85x106 mcL, ferritinaemia 197 ng / mL, calcium 12.9 mg / dL, uricaemia 12.2 mg / dL, creatinine 1.51 mg / dL, VFG according to CKD-EPI 32 ml / min / 1.73 m2, LDH 934 U / L, IgG 627 mg / dL, IgA 44 mg / dL, IgM 281 mg / dL, beta2microglobulin 7 mg / L, CRP 4.8 mg / dL 01 June 2021 orthopedic check: tredimin 50,000 I.U. every 15 days for 6 months 01 June 2021 echo abdomen: "Liver slightly larger than normal (DL lobe DX 17cm). In the right lobe 1 hyperechoic nodule 22mm and 1 hypoechoic nodule 30mm of doubtful attribution ... Very large spleen (DL 21cm) with widespread structural alteration due to the presence of hypoechoic areas up to 4cm. Without color signal ... " 01 June 2021 hematologist: "clinical picture with anemia and thrombocytopenia due to hypersplenism in recent fractures, IR, hypercalcemia, hyperuricemia, high LDH values, inflammation and reduction of peripheral IgG and IgA ..." 07 June 2021 CT scan of the abdomen without MDC: "Slightly enlarged liver.  Marked splenomegaly (160% x 105 mm), presence of small middle III parenchymal calcification.  Some lymphosdenopathies appear to be in the lumbo-aortic area. Lymphadenopathy 30 mm right iliac-femoral region. Oval lymph node short diameter 13 mm ipsilateral inguinal region. ... " 08 June 2021 hospitalization for further investigations. Enter with the help of a walker. June 10, 2021 hematology: posterior iliac crest marrow biopsy June 16, 2021 hematology: inguinal lymph node biopsy: they spoke of "disease neither good nor evil that is treated with chemotherapy" June 22, 2021 hematology: checkup after bone marrow biopsy: they talked about "a rare disease that is treated with chemotherapy" June 25, 2021 hospital discharge: until now no doctor has ever clearly stated what the patient is suffering from: they said to read the discharge letter at home. " Diagnosis of discharge:" Non-Hodgkin B-lymphoid malignant lymphoma, follicular, grade 3 ° sec WHO ". ... Hematology ... 847% of B lymphocytes have large lesions (FSC +++) ... Conclusions: flow cytometric pattern compatible with localization of large cell B lymphoma.  Medullary biopsy: cytological picture free from infiltration, compatible, with medullary hypoplasia with prevalent aspects affecting the erythroid series Lymph node biopsy: morpho-phenotype picture compatible with localization of non-Hodgkin B-lymphoid, follicular malignant lymphoma, grade 3 ° sec. WHO (immunophenotypic profile: CD3-, CD20 +, CD10 +, CD21-, CD23-, Bcl2-, Bcl6-, cMyc - / + (15%), MUM1-, CD5-, EBV-; Ki67 proliferation antigen 80%).  Microscopic description. Iliac crest bone marrow: biopsy needle frustule of hypercellulated osteomedullary tissue with the presence of interstitial infiltration and, predominantly. Diffuse (70%) of small and medium-sized B-lymphoid elements with medullary localization of the lymphoproliferative neoplasm known in the anamnesis (follicular NHL grade 3, leukemized). June 26, 2021 begins to walk safer, always with the help of the walker 05 July 2021 PET 07 July 2021 she can no longer walk, even with the help of a walker: bedridden July 14, 2021 hematology: check after lymph node biopsy: they insist on chemotherapy without saying what the patient has. In the letter to the attending physician: "Conclusions: Non-Hodgkin B-lymphoid, follicular malignant lymphoma, grade 3 °, st IV (marrow), IPI High." July 15, 2021 PET outcome 19-22 July 2021 discussions on chemotherapy July 21, 2021 should have entered the PICC to do chemotherapy. July 30, 2021 request for home palliative care: never had: the doctor is on vacation and no one replaces him. 03 August 2021 CBC: thrombocytopenia 07 August 2021 last full meal: from now on only a few bites in free fall 11 August 2021 at 11:00 (after heated discussions with the doctor for not being admitted to the Hospice) they give her morphine 40 mg / 24h 12 August 2021 at 15:00 dead