Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Pneumonia bacterial, Renal function test, SARS-CoV-2 test positive, Staphylococcus test negative, Systemic inflammatory response syndrome
Clinical narrative: Discharge Provider: PRIVATE MD Primary Care Provider: PRIVATE MD Admission Date: 11/18/2022 Discharge Date: Nov 24, 2022 COVID positive Date 11/16/2022   PRESENTING PROBLEM: Empyema (HCC) [J86.9] Acute respiratory failure with hypoxemia, resolved RML and RLL pneumonia with large loculated right-sided complicated parapneumonic pleural effusion status post chest tube placement and subsequent removal COVID-19 infection   HOSPITAL COURSE: Patient is a 71-year-old female with PMH significant for T2DM, HTN, GERD, UC, history of trauma related multiple right-sided rib fractures/pleural effusion thoracentesis (2015) presents to the hospital 11/13 with  11 day symptoms of dyspnea, nonproductive cough and pain between her shoulder blades that wraps around on the right side.  Patient did not have any fevers but did have sweats.  Patient was noted to be hypoxic needing supplemental oxygen, SIRS (tachycardia, leukocytosis and hypoxia).  COVID PCR was negative.  Chest x-ray showed right-sided consolidative pneumonia.  Patient was admitted to Hospital for CAP and started on Rocephin/azithromycin/vancomycin (discontinued with MRSA screen negative).  On third hospital day, patient was noted to feel poorly after initial improvement, diaphoretic,  soft blood pressures and body aches.  CT thorax obtained which showed loculated right-sided pleural effusion and hence was transferred to alternate Hospital for further evaluation. --patient's pneumonia was treated with Rocephin/azithromycin from 11/13, switched to Zosyn on 11/16 and then to Unasyn on 11/21.  Infectious Disease consultation was also obtained.  Patient has RML, RLL community-acquired pneumonia.  SLP evaluation was negative for aspiration. --patient was noted to have complicated right-sided loculated parapneumonic effusion.  She had IR chest tube placement on 11/18, fluid is exudative, with LDH > 1800 increasing suspicion for empyema however cultures remained without growth.  She also finished 6 doses of tPA/dornase on 11/21 with improved outputs.  A follow up limited CT thorax on 11/23 revealed a markedly improved pleural effusion.  Pulmonary and ID are recommended removal of chest tube which was done on 11/2020.  Patient continued to improve with very minimal pain or trouble breathing . Recommended 4 weeks course of Augmentin was closed Pulmonary, and ID follow-up on a follow-up CT scan in 4 weeks. Patient was subsequently weaned off oxygen and was satting well on room air.   The patient was noted to be positive for COVID-19 on a film array however patient was negative and a PCR at admit on 11/13.  This is of unclear significance.   The patient on antihypertensives at baseline, however due to soft/low normal blood pressures are antihypertensives were held.  This was subsequently resected appetite improving blood pressure.  Patient to resume blood pressure medications and renal function remained stable.   She was discharged home in stable condition with plan to follow up with PCP, Pulmonary and Infectious Disease.