[73024218]
Patient is a (b)(6) male with a history of recurrent mantle cell lymphoma. He received a tcr - alpha/beta and cd19 depleted haploidentical stem cell transplant on (b)(6) 2017. On (b)(6) 2017 he presented to clinic with elevated lfts, diarrhea, and rash on his upper neck, back and upper mid chest. He was admitted for evaluation of his liver and gi symptoms. A liver biopsy and skin biopsy performed on (b)(6) 2017 were both positive for graft-versus-host disease. The patient was started on tacrolimus and budesonide and steroids were increased. On (b)(6) 2017 tpn was started due to limited oral intake. On (b)(6) 2017 the patient was transferred to the critical care unit for worsening hypotension concerning for sepsis and was started on cefepime and flagyl. Blood cultures were positive for pan-sensitive streptococcus vestibularis. Daptomycin was added to the antibiotic regimen. On (b)(6) 2017 the patient went in atrial fibrillation and received metoprolol and diltiazem with no improvement before being started on amiodarone gtt. On (b)(6) 2017 enbrel was added for gvhd, but was discontinued after 2 doses as it was determined the patient was not responding. The patient's mental status seemed to be deteriorating for unclear reasons. Work-up included a lumbar puncture. Csf did not show evidence of lymphoma, however, infectious work-up showed hhv-6 pcr to be positive in the csf. On (b)(6) 2017 it was determined that the patient's status was declining and the acute gvhd was not improving despite critical care measures. The patient's family decided to begin comfort care measures. The patient was transferred to hospice care on (b)(6) 2017 and passed away on (b)(6) 2017 with acute graft - versus - host disease being the cause of death.
Patient Sequence No: 1, Text Type: D, B5