Lumpectomy undergoing chemotherapy

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This is 52-year-old female with right breast cancer (upper inner quadrant) s/p lumpectomy undergoing chemotherapy currently who presented complaining of cough, fever, and lethargy. She was noted to have pancytopenia from chemotherapy, oral mucositis, and hypotension. Patient was diagnosed with septic shock based on the following criteria: temp of 100.6, HR 92, RR of 22 and WBC > 12,000 with lactic acid of 2.6 and persistent SBP < 90 despite adequate volume resuscitation. Chest x-ray and CT chest revealed RML pneumonia. Blood cultures were negative but respiratory pathogen panel showed para influenza. Treatment included peripheral IV administration of vasopressors, Cefepime, Vancomycin, and Azithromycin. Patient was transitioned to oral Levaquin to complete 7 days of antibiotics upon discharge. Grade III oral mucositis due to chemotherapy improved during inpatient stay, stomatitis cocktail was administered. Pancytopenia due to chemo was monitored and pRBC were transfused. Nutrition consult was called for moderate malnutrition due to mucositis (based on ASPEN criteria) and nutrition supplements were ordered. Wound care was consulted for sacral pressure ulcer stage II present on admission. Despite daily dressing changes and frequent turnings, the pressure ulcer progressed to stage III. Final discharge diagnoses: sepsis due to parainfluenza with pneumonia, septic shock, mucositis.

Reference no: EM133816691

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