Age: 71.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Ascites, Back pain
Clinical narrative: Hospitalized (1.3.22);  COVID-19 positive (12.31.21); fully vaccinated PLUS booster DATE OF ADMISSION:  01/03/2022 DATE OF DISCHARGE:  01/08/2022 DISCHARGE DIAGNOSES 1. Severe COVID pneumonia with acute hypoxic respiratory failure. 2. Acute left popliteal deep vein thrombosis. 3. Community-acquired pneumonia ruled out. 4. Chronic left pleural effusion. 5. Diffuse large B-cell lymphoma with splenomegaly and ascites. 6. Hypertension. 7. Iron deficiency anemia. 8. Crohn disease. 9. Chronic back pain. 10. History of prediabetes. 11. Obstructive sleep apnea. 12. Nonischemic troponin elevation due to infection. 13. Mild transaminitis, resolved PROCEDURES 1. CTA thorax. 2. Bilateral upper and lower extremity Dopplers. HOSPITAL COURSE 1. COVID pneumonia.  A 71-year-old patient presented to the ER with chills, dyspnea and dizziness (no falls), and diarrhea.  Symptoms started 12/23 and patient tested positive outpatient, 12/31.  At home, he was hypoxic, using his home pulse oximeter and presented for evaluation.  On presentation, his SpO2 was 77% on room air, temp 39.3 with mild tachycardia (109) and tachypnea (26).  Initially placed on non-rebreather, but rapidly transitioned to high-flow nasal cannula.  CTA of the thorax was negative for PE.  Left pleural effusion was present but was unchanged based on prior CTs.  He was initially started on Decadron, then changed to Solu-Medrol  ***mg/kg per 24 hours.  We felt he was extremely high risk to develop PE given his underlying malignancy, and we elected to start full-dose Lovenox 1 mg/kg q.12 hours.  This was done despite thrombocytopenia and known gastric varices.  Very close monitoring for acute bleeding was done.  He did not show any evidence of acute bleeding during the hospitalization.  He did have lower extremity venous Doppler that showed an acute nonocclusive left popliteal vein DVT.  Right lower extremity negative and both arms negative as well.  Aggressive diuresis was performed throughout the hospitalization.  He slowly improved and by discharge was on room air with an ambulatory pulse ox of 91% on room air.  He received a total of 5 days of steroids during the hospitalization (01/04-01/08) and is being discharged on an additional 5 days of Decadron to complete 10 days of treatment. 2. Acute left popliteal DVT.  Treated with Lovenox 90 mg q.12 hours during the hospitalization and discharged on Eliquis.  Would recommend 3 months of therapy. 3. Hypertension.  Blood pressure was low during the hospitalization.  Norvasc and hydralazine held both during the hospitalization and at discharge.  Blood pressures ranged from 109/70 to 131/74 on the day of discharge.  Would ask PCP to closely follow this and decide when to resume antihypertensives. 4. History of prediabetes.  Treated with very low-dose corrective scale during the hospitalization.  He was not sent home on any medications for diabetes. 5. Chronic thrombocytopenia.  Present since July and felt to be due to chemotherapy.  Last platelet count before discharge (on 01/07/2022) is 102.  No evidence for bleeding. 6. Stage IV diffuse large B-cell lymphoma.  Status post R-CHOP x6 cycles February through June of 2021, requiring multiple dose reductions due to cytopenias.  He has known occluded segment of the splenic vein, left upper quadrant splenic and gastric varices and persistent splenomegaly.  None of these issues were acutely addressed during this hospitalization.  Additionally, his chronic left pleural effusion was not addressed. 7. Crohn disease.  On chart review, it is noted he was on Humira until December 2020.  This was discontinued when lymphoma was diagnosed with no plans to resume