Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory failure, SARS-CoV-2 test positive, White blood cell count increased
Clinical narrative: COVID+ 11/7/22 - Vaccination status - Pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 11/7/2022 Discharge Date: Nov 11, 2022   Active Hospital Problems   Diagnosis Date Noted POA ? Pleural effusion, bilateral 11/11/2022 Unknown Respiratory Failure ? DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Respiratory failure [J96.90] Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: 76-year-old male with a past medical history significant for CLL as well as diabetes in addition of paroxysmal SVT and benign prostatic hypertrophy who presents due to complaints of shortness of breath.  Patient has had insidious onset shortness of breath as well as some bilateral lower extremity swelling.  He noted similar symptoms after recently undergoing nephrectomy approximately 1 month prior.   In the emergency department the patient was found to be as low as 80% on room air requiring 2 L of oxygen.  He had labs obtained which were remarkable for an elevated NT proBNP and 1852. White blood cell count was elevated at 14000. CT PE study was obtained which showed no evidence of PE but he was found to have bilateral pleural effusions, worse on the left with moderate size.  He was also found to have bullous emphysematous lung disease.  He was tested positive for COVID-19.  Blood cultures were obtained, he was started on dexamethasone, thought to warrant admission to the hospital.     Patient's presentation was thought to be related to his COVID-19 status as well as his bilateral pleural effusions.  Reviewing his records, he has had small bilateral effusions for some time and the etiology behind the fusions was uncertain but he did go for bilateral thoracentesis.  He did have 1 L of fluid taken off on the left and he had 450 mL of fluid taken off on the right.  Fluid analysis revealed exudate of effusion and tap at a. Serosanguineous per report.   Based on the patient's history of renal cell carcinoma as well as CLL, with an exudate of effusion that was serosanguineous, concern was had for a possible malignant effusion, especially in light of the fact that the bilateral effusions did reoccur quickly after his tap, although they did remains small.  Pleural fluid initially came back concerning for atypical cells, possibly malignant in nature.  This was communicated with the patient and Oncology and pulmonology were consulted due to concern for reaccumulation of fluid that was thought to be malignant.  Patient was seen by Oncology and further testing was ordered to evaluate the pleural fluid.  However, we analysis of the pleural fluid came back showing that there was actually no atypical cells and no concern for any malignant cells on re-evaluation.  Pulmonology saw the patient with this information and did not recommend pleural drain as the small reaccumulating fluid was not thought to be malignant in nature and repeat chest x-ray 11/11 came back showing slight improvement in the bilateral effusions.   Patient had been able to come off of oxygen after his bilateral thoracentesis and had remained on room air with discontinuation of steroids.  With improved chest x-ray findings by 11/11 and with no evidence on repeat analysis of the pleural fluid suggest malignancy, he was thought to be stable for discharge.  Pulmonology suspected some of his effusions were related to diastolic heart failure there for the patient started on oral furosemide 20 mg daily.  He was discharged in stable condition.