Abstract | April 5, 2022
Breakthrough Case of COVID-19 in a Fully Vaccinated Patient
Learning Objectives
- To recognize and diagnose ARDS associated with COVID;
- To describe the management of COVID-19;
- o demonstrate the complexities that go into determining hospice care for any given patient.
Introduction: Coronavirus Disease 2019 (COVID-19) is caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to over 5 million deaths worldwide including almost 800,000 deaths in the United States alone. Despite the development of multiple vaccines, it still remains a grave threat to many communities around the world as well as the United States. There are very few cases reported on COVID-19 infection a person that is completely vaccinated. Unfortunately, we present a breakthrough case of COVID in a patient fully vaccinated with Pfizer and discuss the outcome the patient faced after testing positive for COVID-19.
Case Report: 84 year-old-female with past medical history of hypertension, chronic obstructive pulmonary disease, Diabetes mellitus type 2 and recurrent mechanical falls presents to the Emergency Room from an assisted living facility after experiencing an unwitnessed fall. She was hypertensive and afebrile on admission. Her only complaint at the time of admission was watery diarrhea over the past week. CT scan of head and face showed no acute hemorrhage. CT scan of cervical, thoracic and lumbar spine revealed some chronic degenerative changes. Two days after admission, patient developed acute hypoxic respiratory failure requiring increasing amounts of oxygen. COVID PCR returned back positive. Her CRP was 83 mg/L and D-Dimer was 839 ng/ml. CT-Angiogram of Chest showed no evidence of pulmonary embolism but was positive for extensive ground glass opacities throughout bilateral upper and lower lobes of the lung.
Final Diagnosis: Acute Respiratory Distress Syndrome from SARS-CoV-2
Management: Patient was treated aggressively with Remdesivir, high dose intravenous methyprednisone and tocilizumab. Furthermore, empiric antibiotics with Vancomycin and Cefepime was also initiated. Despite these aggressive measures, her oxygen requirements continued to increase exponentially. A family meeting was held with the patient, her physicians, the palliative care practitioner, nurses and family members to ultimately decide on the direction of management. Finally, patient was converted to hospice care at behest of family and patient desires.
