Age: 29.0
Sex: F
Vaccine: COVID19
Symptoms: Lip dry, Nasal dryness, Serratia infection
Clinical narrative: Additional information for Item 9: Atorvastatin 10mg, 1x a week. Additional information for Item 10: Cobalt, Nickel, + hydroperoxides of linalool  minor reactions. Additional information for Item 18: 4/9/21 | First covid Pfizer vaccine. 4/10/21 Severe menstrual cramping / bleeding for 15 days. (i skip placebo birth control pills, so should not have gotten a period at all). Mid-April: Saw OB, blood work & vaginal ultrasound came back normal. She linked it to vaccine side effects & said my menstrual cycle would go back to normal in 3 months. 4/30/21 | Second covid Pfizer vaccine, breakthrough bleeding/periods continues. Throughout May, hard pieces of skin begin developing on the peaks of upper lips. As time continues, those hard/dry patches move to the sides of my nose, then back to my lips, and so on. 6/21/21 Severe burning/pain while urinating, I had assumed it was just linked to the ongoing menstrual issues. 7/4/21 Upper and lower lips becoming increasingly dry and chapped. Start experiencing a few days of extreme lethargy. (this will start to become 1-2x a week from here on out). 7/25/21  7/29/21 Severe vaginal burning/irritation. Call OB, she advises that it's a yeast infection and to get a 3-day Monistat from Pharmacy. 8/4/21  8/6/21 Severe dryness/swelling/burning/itching on both upper and lower lips (almost as if having an allergic reaction). Teledoc appointment - was told this could be a systemic yeast infection. Prescribed Mupirocin and Ketoconazole topicals. Called OB to update her, she agreed that it was a systemic yeast infection and told me to continue topicals. Prescribed fluconazole 150mg once every 6 days for 4 weeks. Touchbase with GP to fill her in, she agrees with the above diagnosis. 8/11/21  9/19/21. Some relief on both upper and lower lips, but continued severe dryness in addition to a more pronounced, red lip line. Severe eye/throat irritation (itchiness, dryness) Menstrual cycle has returned to normal. 9/22/21  9/26/21Major upper and lower lip flare-up. Severe swelling, itching, burning, in addition to 3 key locations with pus (peaks on upper lips + middle of lower lip). Continued eye/throat discomfort, Appointment with GP, she refers me to a Dermatologist. 9/27/21 Dermatologist appointment: Concluded that it was allergy based, prescribed topical steroid (Desonide .05%) and daily Zyrtec. After further discussion, also took bacterial culture to rule out bacterial infection. Throughout the week, lethargy is increased to 3-4 days as well as pretty bad chills. 10/1/21 Culture Results: Heavy growth of Serratia Liquefaaciens. Dermatologists takes me off zyrtec + desonide, prescribes Gentamicin. Discuss results with GP, she refers me to an Infectious Disease doctor. Recommended to MD to get blood work/culture & urine tested to have all results in time for ID appointment. Temperature 99.3. Blood Sugar 49. All other results were normal 10/4/21 - 10/5/21: Burning and itching on upper lip, turning into some small blistering outside of the lip line. Dermatologist followed up with additional results which showed yeast growth. She wants to take a viral culture, switch me to an oral antibiotic and put me on nystatin anti-fungal topical. 10/6/21 Allergist Appointment: Doctor does not think it's cold sores since nothing has ever scabbed over. He says there is skin sloughing although unsure as to what is causing it.  Took a bacterial culture, and will be doing a patch test on 10/11/21 to rule out any eczema or chemical allergy.  10/7/21 Dermatologist Follow up: Dual-treatment medication (topical, gentamicin 3x a day & oral, levofloxacin 750mg) for a week.  He would potentially recommend a lip biopsy, but is deferring to the Infectious Disease doctor's treatment plan. 10/8/21 Worst flare up yet, really swollen and raw lips/face. Super painful, really itchy, almost went to ER. 10/11/21 Allergist appointment for patch test. 10/13/21 Allergist appointment, patch test & culture results. Very few allergies shown from patch test, which confirms that there is no allergy correlation to what's been happening on my lips. Culture results showed moderate yeast growth, and no serratia growth. He is deferring to the ID for treatment. 10/15/21 Infectious Disease Appointment: Thinks Serratia + Yeast are secondary infections from an underlying cause. Prescribed Fluconazole 100mg 1x a day for 7 days, as well as topical (using ketoconazole in the meantime) 2x a day for 7 days. Did bloodwork to test for vitamin levels / tb. UPCOMING: 10/22/21 Infectious Disease Follow up Appointment, 10/27/21 Dermatologist Lip Biopsy, 11/4/21 Dermatologist Follow up, 1/12/22 Dermatologist.