Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Leukocytosis, Lung opacity, Pleural effusion, Pneumonia, Pneumonia bacterial
Clinical narrative: COVID + - reported as approximately 10/29/22.  Vaccination status - pfizer x2 + moderna x1 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 11/7/2022 Discharge Date: Nov 9, 2022  Active Hospital Problems   Diagnosis Date Noted POA ? Community acquired bacterial pneumonia 11/07/2022  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Community acquired bacterial pneumonia   HOSPITAL COURSE: 46-year-old female with a past medical history significant for cerebral palsy as well as epilepsy presents due to cough and lethargy.  Of note, patient had been tested in the outpatient setting and was found positive for COVID-19 approximately 10 days prior to admission and had received paxlovid. She was previously vaccinated.   In the ER the patient was hypoxic on room air 87% but did require as much as 7 L at 1 point.  Chest x-ray showed a possible left lower lobe infiltrate.  Labs were remarkable for leukocytosis.  Patient started on ceftriaxone, azithromycin, and thought to warrant admission to the hospital.   Patient was able to wean down to 2 L of oxygen during her hospital stay and was continued on this early on.  She remained afebrile.  Urine Legionella and urine Streptococcus pneumoniae antigens came back negative but she was continued on antibiotics.   Although 1 blood culture did come back positive, this was found to be coagulase-negative Staph and was thought to be likely a contaminant.   Patient had clinical improvement according to her mother who was at her side throughout her hospitalization.  Eventually, the patient was able to wean down to room air oxygen.   As the patient had returned almost her baseline state and was on room air and afebrile, she was thought to be appropriate for discharge home on 11/09/2022.  She was discharged in stable condition and transition to liquid suspension of antibiotics to complete a 5 day course of antibiotic therapy for possible community-acquired pneumonia.  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 11/13/2022 Discharge Date: Nov 18, 2022 Active Hospital Problems   Diagnosis Date Noted POA ? Cerebral palsy 11/13/2022 Yes ? Pneumonia 11/07/2022 Yes ? Focal epilepsy    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pleural effusion Pleural effusion, left  HOSPITAL COURSE: 46 y.o. female with PMHx of severe developmental delay, cerebral palsy, epilepsy who presented with increased work of breathing, gurgling/coughing, and fever of 101.4. Patient lives at home with parents who are her caretakers. She was recently hospitalized 11/07/2022-11/09/2022 with community acquired pneumonia.  She was treated with rocephin and azithromycin and discharged on Augmentin which she completed last night. Per mother, the patient was doing well since day of discharge.    In the emergency room, the patient was tachycardiac and tachypnic.  Labs showed a leukocytosis.  Chest xray revealed a left sided complete opacification and large left pleural effusion.  VBG was stable.  O2 saturations remained in mid 90s on 2L NC.  She was admitted to hospitalist.   IR and ID consulted. IR performed L thoracentesis. Fluid studies neg for empyema, cultures did not isolate a bacteria.  ID was consulted to comment on two separate occasions of blood cultures with staph epidermidis. They state it was likely from difficult venipuncture and contamination with no need to treat. They recommended completing course of antibiotics for PNA with Augmentin, through 11/19.   During hospital stay patient also had PGJ tube replaced as it had been leaking. On 11/15 the tube became clogged and IR consulted again for replacement which was done on 11/17. She was evaluated for repeat thoracentesis on left, but no fluid collection and after deep suctioning she returned to her baseline breathing and appeared comfortable to family.   Given the working PGJ tube and respiratory stability, she was discharged in stable condition home on 11/18. She will complete Augmentin through 11/19. CONSULTS / RECOMMENDATION: Infectious disease Interventional radiology