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Name: Patient Date of Birth: MRN: Primary Care Physician at Discharge: MD Hematologist/Oncologist: MD Admission Date: 12/7/2023 Discharge Date: 12/10/2023 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Febrile neutropenia [D70.9, R50.81] Severe sepsis (HCC) [A41.9, R65.20] HOSPITAL COURSE: Patient is a 7 y.o. male with PMHx T Cell ALL in remission, who is admitted with febrile neutopenia in the setting of COVIC-19. Patient had been evaluated in the clinic for day 31 interim maintenance II therapy like COG ALL0434, but secondary to neutropenia did not meet parameter to proceed with therapy. He had new cough and rhinorrhea, with known sick contacts, and thus a film array was obtained and notable for COVID-19. Peds ID reviewed his case and he was found to be eligible for IV Remdesevir, (paxlovid ineligible due to age), however given his mild symptoms and necessity to admit for infusion, decision was made not to proceed. He was discharged from clinic with plan for close follow-up. Unfortunately, shortly after leaving, patient developed a fever of 102 and presented to the ER for further assessment. No notable GI symptoms; at baseline eating, activity, and urination. No respiratory worsening. Fastbreak protocol was initiated with central/peripheral blood cultures drawn, fluid bolus and cefepime given. CBC demonstrated persistent neutropenia with ANC 430. CMP with mild transaminitis. Procal 1.04 without evidence of bacterial pneumonia on CXR. UA was negative for infection. He was admitted for further monitoring and treatment. He was started on IV Remdesivir with loading dose (1mg/kg) given overnight and subsequent doses (0.5mg/kg) scheduled daily; maintained in severe respiratory precautions. On 12/8, CBC showed worsening anemia and he received 1 unit pRBCs with excellent response. He was continued on empiric Cefepime through 12/10. Blood cultures were NGTD at > 48 hours. He completed remdesivir 3 day course as clinically he remained well without significant complication of Covid infection. He had no further fevers during admission. CBC and CMP continued to be monitored daily and by the time of discharge, ANC was overall stable at 380. Day 31 therapy was deferred to 12/11 with f/up scheduled in the PHO clinic. It was discussed that he should remain with masking precautions for ongoing Covid infection for 21 days given immunocompromise and prolonged viral shedding with additional isolation as able thru 12/12 (apart from necessary medical appointments). Father was advised to return for any further fevers > 101F and for worsening respiratory status as this could be indication of secondary bacterial pneumonia. All questions answered. Port was de-accessed prior to discharge. His next LP will be deferred to 1/8/2024 with start of maintenance therapy.