Age: 16.0
Sex: M
Vaccine: COVID19
Symptoms: Immunoglobulin therapy, Immunosuppressant drug therapy, Laboratory test, Left ventricular dilatation, Left ventricular dysfunction
Clinical narrative: Admission Date/Time: 12/19/2021 12:11:00  Discharge Date/Time: 12/21/2021 12:13:10  Chief Complaint  chest pain  Patient Narrative          Patient is a previously healthy 16yM w/ GERD p/w 1d chest pain and ST elevations on EKG at urgent care.Patient was in USOH when he got his COVID booster vaccine 5d ago (12/14). Afterwards, he had a day of muscle soreness similar to the symptoms he had after his 2nd COVID vaccine. Because of the chest pain, patient went to outside urgent care where he was found to have ST elevations on inferior leads and troponins elevated to 12.5 (upper limit 0.05). Patient was then sent to ED. Labs showing elevated troponin 1.49, CRP 2.85, ESR 10.  He was admitted to cardiology service with differential diagnosis of post covid vaccine myocarditis. He was started on immun suppresive treatment for presumed post vaccine myocarditis. Initial ECHO was consistent with Mild left ventricular dilatation. Mild left ventricular systolic dysfunction. Qualitatively normal right ventricular systolic function. No significant valve dysfunction. No pericardial effusion.  He has completed a course of IVIG and  started on  5 day course of methylprednisone. Currently, he is at his baseline and without symptoms. The ST segment elevation have nearly normalized with non-specific ST segment changes. Troponin levels downtrended to 0.95, with most recent one being 1.01 . Repeat ECHO was done on day 3 of admission  that showed improved LV function compared to admission ECHO. His cardiac MRI changes was reviewed by radiology also found to be consistent with myocarditis. He is going to complete his 5 day steroid course at home and will be seen as outpatient for follow up on 12/29 with Dr.  Tests Pending  No tests pending at time of discharge    These tests will be followed by the Primary Service at Discharge after Discharge  Vitals and Discharge Physical  T: 36.9  °C  (Temporal Artery)  HR: 66 (Monitored)  RR: 18  BP: 106/50  SpO2: 98%  HT: 177.8 cm  WT: 90.4 kg   Discharge Physical Exam  General: alert, no acute distress, normal hydration, not ill appearing Skin: no rash, warm, dry Head: atraumatic, normocephalic Eye: normal conjunctiva, sclera clear, no discharge, pupils equal, round, reactive, extraocular movements intact ENT: RTM normal, LTM normal, pharynx: normal, normal tonsils, mouth: moist mucus membranes, no lesions Neck: supple, trachea midline, no adenopathy, no tenderness Cardiovascular: regular rate and rhythm, no murmur, normal peripheral perfusion Respiratory: lungs CTA, respirations non labored Chest wall: no tenderness, no deformity Gastrointestinal: soft, nontender, nondistended, normal bowel sounds, no organomegaly Musculoskeletal: no deformity, no tenderness, normal range of motion, no joint swelling  Diagnosis List  1. Adverse reaction to immunization, 12/19/2021 2. Chest pain, 12/19/2021  Procedure History  No Procedure History  Social History  Smoking Status      No Smoking Status Documented  Allergies  No known allergies Other Relevant Laboratory Results   ECHO 12/19  Mild left ventricular dilatation.  Mild left ventricular systolic dysfunction.  Qualitatively normal right ventricular systolic function.  No significant valve dysfunction. No pericardial effusion. ECHO 12/21  High-normal left ventricular size with low-normal systolic function - improved. Mild eccentric left ventricular hypertrophy. Qualitatively normal right ventricular systolic function. Normal valve function.? No pericardial effusion.     Microbiology Results (Last 30 Days)  Viral Respiratory panel negative, covid antibody negative  Immunizations  Covid booster on 12/14/202 Patient likely had myocarditis following his booster (3rd dose) of COVID-19 immunization that has low-normal function, but is currently asymptomatic. We will have him restricted from strenuous activity and competitive sports for 3 months. We will have him continue on the prednisone for 2 more days (5 total days) without a taper. He has follow-up in one week.