COVID discharge 85+ yo M with dementia, prior MRSA septic | Figure 1

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COVID discharge

85+ yo M with dementia, prior MRSA septic arthritis maintained on suppressive doxy, dementia and a stage IV sacral wound admitted from SNF with cough, found to have COVID pneumonia. He was treated with 5 days Azithro/hydroxychloroquine and max O2 requirement was 4 L NC. He was discharged back to SNF after 20 days. One would think the mortality rate would be very high in someone this old and frail. First image is CXR on admission, second is hospital day 11.

Case Details

64 yo F w/ HTN, HLD discharged after a week long admission with COVID 19. Initial chest x-ray performed at an ED and cefuroxime/doxycycline prescribes. COVID subsequently returned positive and she had worsening symptoms of cough and dyspnea. Repeat cxr 4 days after ED presentation with worsening infiltrates. Procalcitonin undetectable, no lymphopenia. Doxy/cefuroxime discontinued, started in azithro + hydroxychloroquine. She did not develop hypoxemia. Sadly, her husband also had COVID and is on a ventilator.

A 42-year-old male presented to the emergency department for treatment of a rectal abscess. He reported a several day history of dry cough. He’s otherwise healthy with no past medical history and no recent travel. Oxygen saturation was 99% on room air. Leukocytosis was attributed to the abscess. A CT abdomen and pelvis to investigate the extent of the rectal abscess incidentally revealed bilateral basal pneumonia with ground glass appearance suggestive of COVID. He didn’t meet CDC requirements for screening, however a COVID nasal swab was sent to a private lab. He’s currently admitted and in isolation, receiving IV antibiotics. Vital signs are stable, and the dry cough persists. Awaiting results of the COVID results.

65 yo male. He’s been in ICU for 18 days now. COVID-19 clinically confirmed, negative PCR. On day 7th he presents a pulmonary embolism of the right main pulmonary artery and other lobar arteries. He’s started on anticoagulation. On day 15th subcutaneous emphysema starts to show up and the patient, which was clinically improving and on pressure support with an inspiratory pressure of 10, starts to demand a higher inspiratory pressure to be properly oxygenated. Brownish sputum is now being reported by ICU nurses. Lab results remain fairly normal with a slight increase of PCR from 1 to 3. D dimers going up. We finally decide to transport him to CT and these are the findings:

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