J&J Dose 03/31/21 (1808978) COVID Positive 8/9/2021  8/9/21: This 40 yo M patient in previous good health was found to have bacterial endocarditis of both the aortic and mitral valves requiring open heart surgery and valve replacement with mechanical valve requiring anticoagulation, in June of this year, and then was found to have a lytic lesion on a bone eventually diagnosed with multiple myeloma also in June of this year.  He is currently on chemotherapy and steroid therapy through the Oncology Department.  He did receive his Johnson & Johnson COVID-19 vaccine in April, but now has been ill for the past 2 days.  Had a severe coughing spell during which he felt like he broke a rib.  He had increasing fever, chills, headache, myalgia and weakness.  He went to a walk-in clinic with a fever of 102 and respiratory rate of 30. He was sent to the emergency room where CT scan of the chest shows bilateral ground grass appearing infiltrates and a positive COVID-19 test.  He has not required supplemental oxygen but had with his immunosuppressant a state is high risk for worsening of the COVID despite his vaccine.  He is being admitted to the hospital for aggressive monitoring and therapy.  The CT scan also shows a possible compression fracture of L1 which may account for his broken rib like pain, along with lytic lesions in the right acetabulum.  Orthopedics had been informally consulted and said that he would need to go to the Orthopedic clinic at some point and may be at risk for fracture in the future.  The patient has been ambulating with not that much pain in his right hip or leg. No pulmonary emboli were seen on the CT scan.  He has been taking his warfarin but they did not check an INR test today or a CRP to estimate the degree of inflammation.  We will admit the patient for IV antibiotics for possible community-acquired pneumonia but also will start antiviral therapy and dexamethasone anticipating his COVID-19 may rapidly get worse.  8/11/21: Patient is a 40-year-old male with PMHx significant for multiple myeloma on immunosuppressant therapy with associated lytic lesions and bacterial endocarditis s/p valve replacement on chronic long-term anticoagulation who presented with tachypnea, fever, chills, headache, myalgia and generalized weakness.  In the ED, patient was febrile to 102.0 F and tachypneic to 30 breaths per minute.  CT scan of the chest demonstrated bilateral ground-glass opacities concerning for viral pneumonia.  CT was negative for PE.  COVID-19 testing was positive.  Notably, patient has completed the COVID-19 vaccination series.  Given concern for patient's immunosuppressed state and worsening respiratory status, he was admitted to the hospital for aggressive monitoring and therapy.  Patient was started on remdesivir given his marked tachypnea.  Patient was not hypoxic and did not meet criteria for dexamethasone.  Patient was additionally started on vanc/Zosyn empirically for any overlying bacterial pneumonia.  Patient's respiratory status improved on remdesivir.  He never required supplemental O2 during hospitalization.  He was transitioned to Augmentin to complete 5 total days of antibiotic therapy.  Case was discussed with oncology outreach clinic. Patient has a scheduled appointment on 08/19/2021 at 1515 at which time he will be evaluated to resume chemotherapy. Oncology nurses will contact him in regards to his oral immunosuppressants.   Additional workup during hospitalization was performed due to patient's increasing pain.  CT abdomen/pelvis noted a compression fracture of L1 in addition to lytic lesions within the right iliac wing and acetabulum.  orthopedics was consulted and recommended follow-up with them as an outpatient.  It.  Patient was provided a front wheel walker to help with ambulation.   Patient expressed desire to discharge home and was subsequently discharged with the COVID safe at home program.  He was also instructed to complete Augmentin twice daily for 3 additional days to complete 5 total days of antibiotic therapy.  Patient was instructed to follow up with the Oncology Clinic.  He was also instructed to follow-up with his PCP within 7 days.