Preview
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC. NO. 84 RECEIVED NYSCEF: 10/28/2022
Exhibit G
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 1 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
Author: Mounica Yanamandala, MD Service: Internal Medicine Author Type: Resident
Filed: 10/22/2017 6:35 PM Date of Service: 10/22/2017 12:35 PM Creation Time: 10/22/2017 12:35 PM
Status: Signed Editor: Mounica Yanamandala, MD (Resident)
Cosigner: Laila Khalid, MD at 10/24/2017 11:52 AM
INPATIENT DISCHARGE SUMMARY
Primary Care Physician at Discharge: Mentor Sejdiu, MD
Admission Date: 10/20/17 Discharge Date: 10/22/2017
Reason for Admission: SJS/TEN
Presenting History:
76F h/o gout, CKD, dementia, admitted to Montefiore New Rochelle 10/15/17 for fever, AMS, LE edema, now
transferred to Moses for suspected SJS/TEN.
Patient AOx1 and poor historian, hx obtained from accompanying medical records. Several weeks ago, patient fell
from bed and was admitted to Lawrence Hospital, discharged the next day. Upon arrival home, family noted hives and
pruritic maculopapular rash throughout body, sparing palms and soles. Family concerned sxs 2/2 food allergy
(tomato). PMD had started patient on cyproheptadine prior to that admission, unclear when stopped. Rash worsened,
patient developed generalized weakness, was taken to St. Lukes Hospital, received unknown treatment for rash
(cannot recall), IVF, symptoms improved so patient discharged to Sutton Park rehab 10/5/17. On 10/14/17, patient
developed fever, daughter noticed open lesions on chest and behind right ear with purulent discharge and AMS,
patient brought to New Rochelle.
At New Rochelle, admitted for evaluation and treatment of desquamating skin lesions on back, chest, and behind R
ear. Allopurinol stopped on admission. Affected BSA <10%, suspected SJS. R ear lesion was bleeding, patient anemic
to 6.9, received 1u pRBC. Was unable to obtain dermatology consult at New Rochelle. Started on IVF for hydration, IV
methylprednisolone 70mg QD, aztreonam and vancomycin IV x1. Abx dc'd after ID consulted. Skin care provided with
silvadene and chlorhexidine, silvadene changed to mupirocin after WBC increased. LE doppler showed L common
femoral DVT, started on therapeutic Lovenox. Guaiac positive, Lovenox held x 1 day, transfused 1u pRBC, AC
restarted after Hgb stable. Skin wound cx MRSA positive, put under contact isolation.
Review of labs from New Rochelle reveal peripheral eosinophilia, now resolved, leukopenia, anemia. TSH 13.89, fT4
1.08. Uric acid ~8, Cr ~1.5, Alk phos ~150, HCO3 ~18. Parvo B19 IgG pos, IgM neg, HIV neg, CMV neg. Wound cx
with MRSA. CTH neg for ICH or mass effect, partial empty sella. CXR neg. Skin bx with interface dermatitis, ddx
includes DRESS, fixed drug reaction, SJS/TEN, erythema multiforme.
Patient transferred to Moses for dermatology evaluation. Patient states she has had this diagnosis before 2-3 years
ago. Denies pain.
SH: reports h/o smoking
PMH: CKDIII, HTN
PSH: none documented
Meds:
APAP 325 q6h
Bacitracin ointment
Generated on 11/20/20 7:20 AM Page 1216
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 2 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
Trazodone 25mg qd
Lovenox 60mg qd
Lasix 20mg PO qd
Levothyroxine 25mcg qd
Methylprednisolone 70mg IV qd
Multivitamin qd
Mupirocin topical ointment
Pantoprazole 40mg IV q12h
Vitamin D3 2000 IU
Allergies: tomato, ?cyproheptadine, ?allopurinol, PCN
Presenting Physical Exam:
Gen: Awake and alert. NAD. AO to person, not to time or place.
Skin: Numerous sloughing skin lesions on anterior chest, back, neck. + Nikolsky sign. Numerous 1cm nonblanching
purpuric lesions scattered through BL LE. Minimal oozing of large anterior chest lesion.
HEENT: Anicteric sclerae. No mucosal lesions noted. PERRL.
CV: RRR, 2/6 systolic murmur at apex.
Resp: Bibasilar crackles.
Abd: Soft, NT/ND. BS present. No rebound or guarding.
Ext: No pedal edema. 2+ DP pulses BL.
Diagnoses:
Hospital Problems
Hospital
* (Principal)SJS-TEN overlap syndrome (Chronic)
Non-Hospital Problem
Non-Hospital
Stevens-Johnson syndrome (Chronic)
Routine general medical examination at a health care facility
Special screening for malignant neoplasms, colon
Other screening breast examination
Hyperlipidemia
Other malaise and fatigue
Tobacco use disorder
Other acquired absence of organ
Essential hypertension
Depression
Other and unspecified alcohol dependence, unspecified drinking behavior
Pain in joint, hand
Loss of weight
Abdominal tenderness, left lower quadrant
Sleep apnea
Special screening for malignant neoplasms, colon
Encounter for screening for osteoporosis
Osteoarthritis of spine
Difficulty walking
Gout
Edema
Chronic kidney disease, stage III (moderate)
Hypertensive kidney disease, stage 1-4 or unspecified chronic kidney disease
Preoperative examination
Generated on 11/20/20 7:20 AM Page 1217
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 3 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
Exophthalmos
Major depressive disorder, recurrent episode, in full remission
Brachial neuritis or radiculitis
Cervicalgia
Special screening for malignant neoplasms, colon
Primary osteoarthritis of left hip
Drug allergy
Urticaria due to drug allergy
Penicillin allergy
Hospital Course
Patient with a greater than 1 week history of desquamating rash, dusky violaceous papules and plaques, and
eosinophilia. Lesions involve close to 30% of her body surface area without any mucosal or genital involvement.
Patient was transferred from New Rochelle to Montefiore Moses for dermatology evaluation due to concern for
SJS/TEN. Dermatology evaluated patient, and obtained a fresh frozen skin sample from central upper chest. Based on
their evaluation, there is clinical concern for SJS/TEN or DRESS, and recommended that patient be transferred to the
Jacobi Burn Unit for further evaluation. Patient was started on steroids at New Rochelle; however, without significant
improvement in skin lesions. Dermatology recommended tapering down of steroids. She was initially on
methylprednisolone 70 mg daily, and is now currently receiving methylprednisolone 40 mg daily. Dermatology
recommending use of IVIG 3 gm/kg/day. Nephrology was consulted to assist with choosing IVIG that would be least
nephrotoxic. They recommend IVIG (Gamunex-C) which would be the least nephrotoxic, and should be given at the
lowest rate possible and with hydration. As patient is being transferred to Jacobi, will defer starting until patient arrives
there.
With regards to patient's DVT, she was noted to have a left common femoral DVT at New Rochelle and was started on
therapeutic lovenox. She had some oozing at skin sites, and was noted to be guaiac positive (though no melena was
noted). She received 1U PRBC. Hemoglobin has been stable during hospitalization at Montefiore, and lovenox was
continued. Of note, patient's Cr has been rising during hospitalization from 1.1 to 1.6. Would consider changing
lovenox to heparin.
Also, skin wound culture MRSA positive, put under contact isolation.
Patient's family members were contacted and notified of her transfer to Jacobi. Son is Kevin Lynch at 874-303-1979
and sister is Delores Harris at 914-319-0129.
Pertinent Results:
Results from last 7 days
10/22/17 10/20/17
Lab Units
0408 2232
WBC k/uL 5.3 3.9*
HEMOGLOBIN g/dL 9.2* 8.4*
PLATELET COUNT k/uL 305 223
Results from last 7 days
10/22/17 10/20/17
Lab Units
0408 2232
SODIUM mEq/L 143 142
POTASSIUM mEq/L 5.6* 5.5*
Generated on 11/20/20 7:20 AM Page 1218
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 4 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
CHLORIDE mEq/L 112* 113*
CO2 mEq/L 15* 13*
BUN mg/dL 39* 37*
CREATININE mg/dL 1.60* 1.40
GLUCOSE mg/dL 86 104
CALCIUM mg/dL 8.3* 8.5
MAGNESIUM mg/dL 2.0 --
PHOSPHORUS mg/dL 5.0* --
No results found for: BNP
No results found for: TROPONINT
Results from last 7 days
10/22/17 10/20/17
Lab Units
0408 2232
AST U/L 35 42
ALT U/L 32* 23
ALK PHOS U/L 135 171*
BILIRUBIN TOTAL mg/dL 1.0 0.7
BILIRUBIN DIRECT mg/dL 0.2 0.3
PROTEIN TOTAL g/dL 4.9* 5.2*
ALBUMIN g/dL 1.9* 2.3*
Procedures & Surgeries
DERM PATH (10/19/17)
. Skin, site unspecified, biopsy (2 slides labeled RS1704683 1-1 and 1-2):
- INTERFACE DERMATITIS.
Note: The differential diagnosis includes a drug reaction, disseminated fixed drug reaction, or drug rash with
eosinophilia with systemic symptoms (DRESS). The findings could also be seen in the erythema multiforme
-Stevens-Johnsonsyndrome-toxic epidermal necrolysis spectrum of diseases.
Clinicopathological correlation is necessary.
Physical Exam at Discharge:
Gen: patient lying in bed, generalised tremors, conversant, says feels improved
Resp: CTAB
CVS: s1 and s2 audible
Abd: soft non-tender
Skin: lesion on eyelid, none around mouth, neck (desquamating), multiple small lesions on the back, some are
desquamating; likely covering 10-30% of the skin area
Genital exam: no lesions noted
Allergies:
Allergies
Allergen Reactions
•Cyproheptadine
?SJS
•Levaquin [Levofloxacin] Steven Johnson Syndrome
•Allopurinol Analogues Rash
Generated on 11/20/20 7:20 AM Page 1219
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 5 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
•Colchicine Analogues Rash
•Rocephin [Ceftriaxone] Rash
Medications:
Current Facility-Administered Medications
Medication Dose Route Frequency
•acetaminophen 32 975 mg oral once
mg/mL oral liquid 975 mg
•acetaminophen tablet 650 mg oral Q6H PRN
650 mg
•chlorhexidine 4 % topical topical Q12H
liquid
•dextrose 5 % and sodium 1,000 mL intravenous continuous
chloride 0.45 % infusion
•enoxaparin injection 80 1 subcutaneous Q24AD
mg mg/kg/DO
SE
•levothyroxine 25 MCG in 25 MCG intravenous daily
NS (20 mcg/mL) IV
syringe
•methylPREDNISolone 40 mg intravenous daily
sodium succinate 40
mg/mL injection 40 mg
•mupirocin 2 % ointment topical Q8H
Immunizations given during hospitalization
The primary reason for admission status is deteriorated.
Discharge Disposition
Acute Care Hospital
Follow-up for Post-Discharge Provider:
1. Continue to taper down steroids
2. Start IVIG per dermatology recommendations
3. Monitor renal function
4. Likely switch from enoxaparin to heparin ggt
5. IV hydration
Outpatient Follow-Up
Future Appointments
Date Time Provider Department Center
Barry
12/30/ 8:40 Southeast
Fomberstein, BXERHEUM
2017 AM Br
MD
Test Results Pending at Discharge
Generated on 11/20/20 7:20 AM Page 1220
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 6 MOSES NW4W
111 East 210 Street
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017
10/20/2017 - Admission (Discharged) in MOSES NW4W (continued)
Discharge Summary (continued)
Order Current Status
SURGICAL PATHOLOGY TEST In process
SURGICAL PATHOLOGY TEST In process
Electronically signed by Mounica Yanamandala, MD at 10/22/2017 6:35 PM
Electronically signed by Laila Khalid, MD at 10/24/2017 11:52 AM
Version 2 of 3
Author: Mounica Yanamandala, MD Service: Internal Medicine Author Type: Resident
Filed: 10/22/2017 1:51 PM Date of Service: 10/22/2017 12:35 PM Creation Time: 10/22/2017 12:35 PM
Status: Shared Editor: Mounica Yanamandala, MD (Resident)
Cosign Required: Yes Cosigner: —
INPATIENT DISCHARGE SUMMARY
Primary Care Physician at Discharge: Mentor Sejdiu, MD
Admission Date: 10/20/17 Discharge Date: 10/22/2017
Reason for Admission: SJS/TEN
Presenting History:
76F h/o gout, CKD, dementia, admitted to Montefiore New Rochelle 10/15/17 for fever, AMS, LE edema, now
transferred to Moses for suspected SJS/TEN.
Patient AOx1 and poor historian, hx obtained from accompanying medical records. Several weeks ago, patient fell
from bed and was admitted to Lawrence Hospital, discharged the next day. Upon arrival home, family noted hives and
pruritic maculopapular rash throughout body, sparing palms and soles. Family concerned sxs 2/2 food allergy
(tomato). PMD had started patient on cyproheptadine prior to that admission, unclear when stopped. Rash worsened,
patient developed generalized weakness, was taken to St. Lukes Hospital, received unknown treatment for rash
(cannot recall), IVF, symptoms improved so patient discharged to Sutton Park rehab 10/5/17. On 10/14/17, patient
developed fever, daughter noticed open lesions on chest and behind right ear with purulent discharge and AMS,
patient brought to New Rochelle.
At New Rochelle, admitted for evaluation and treatment of desquamating skin lesions on back, chest, and behind R
ear. Allopurinol stopped on admission. Affected BSA <10%, suspected SJS. R ear lesion was bleeding, patient anemic
to 6.9, received 1u pRBC. Was unable to obtain dermatology consult at New Rochelle. Started on IVF for hydration, IV
methylprednisolone 70mg QD, aztreonam and vancomycin IV x1. Abx dc'd after ID consulted. Skin care provided with
silvadene and chlorhexidine, silvadene changed to mupirocin after WBC increased. LE doppler showed L common
femoral DVT, started on therapeutic Lovenox. Guaiac positive, Lovenox held x 1 day, transfused 1u pRBC, AC
restarted after Hgb stable. Skin wound cx MRSA positive, put under contact isolation.
Review of labs from New Rochelle reveal peripheral eosinophilia, now resolved, leukopenia, anemia. TSH 13.89, fT4
1.08. Uric acid ~8, Cr ~1.5, Alk phos ~150, HCO3 ~18. Parvo B19 IgG pos, IgM neg, HIV neg, CMV neg. Wound cx
with MRSA. CTH neg for ICH or mass effect, partial empty sella. CXR neg. Skin bx with interface dermatitis, ddx
includes DRESS, fixed drug reaction, SJS/TEN, erythema multiforme.
Patient transferred to Moses for dermatology evaluation. Patient states she has had this diagnosis before 2-3 years
Generated on 11/20/20 7:20 AM Page 1221
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 7 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
Author: Eriko Kida, PA Service: Internal Medicine Author Type: Physician Assistant
Filed: 2/7/2018 3:35 PM Date of Service: 1/30/2018 11:09 AM Creation Time: 1/30/2018 11:09 AM
Status: Signed Editor: Eriko Kida, PA (Physician Assistant)
Cosigner: Clyde H Weissbart, MD at 2/10/2018 1:57 PM
INPATIENT DISCHARGE SUMMARY
Primary Care Physician at Discharge: Mentor Sejdiu, MD
Admission Date: 1/25/18 Discharge Date: 02/07/18
Reason for Admission: Failure to thrive and Anorexia
Presenting History: 76 Y old F from Workmen's Circle NH with PMH of Gout, CKD stage 4 , mild cognitive
impairment, h/o of SJS treated with high dose steroids.
Patient presented with poor oral intake, refusing to eat for above a year now and patient has lost around 100 lbs in a
year. Nothing makes it better or worse.
Per son Mr Kevin Lynch, Tel: 864-303-1979, Patient has been refusing to eat for a year now and that this has been
worsening since October 2017 when the patient was receiving the treatment for a suspected SJS secondary to severe
drug allergy. Son has tried everything to enhance her appetite and only noticed mild improvement at few times.
When asked the patient, she mentioned that she doesn't like the taste of food presented to her and that she doesn't
feel like eating and that she is feeling depressed recently but she denies any feeling of helpless ness or hopelessness,
any suicidal or death ideas but reported difficulty sleeping, also she denies any mistreatment from her family, saying
that they come and visit her regularly.
No Chest pain, SOB, Nausea, vomiting, abdominal pain, diarrhea, leg swelling, dysuria.
Presenting Physical Exam:
Constitutional:
Well developed, well nourished, in no acute distress.
Skin: Patchy healed dark pigmented skin lesions in her face, lower extremity and her back.
Eyes:No ptosis, conjunctivae clear, sclerae anicteric, PERRL, EOMI.
Exophthalmos is noted bilaterally .
Pulmonary/Chest:
Clear to auscultation; no crackles, rhonchi, or wheezing.
Cardiovascular: Regular rate and rhythm with no murmurs, rubs or gallops.
Abdominal: Normal bowel sounds, soft, non-tender and non-distended without masses, organomegaly..
Diagnoses:
Hospital Problems
Hospital
Failure to thrive (0-17)
Non-Hospital Problem
Non-Hospital
Stevens-Johnson syndrome (Chronic)
SJS-TEN overlap syndrome (Chronic)
Routine general medical examination at a health care facility
Generated on 11/20/20 7:19 AM Page 501
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 8 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
Special screening for malignant neoplasms, colon
Other screening breast examination
Hyperlipidemia
Other malaise and fatigue
Tobacco use disorder
Other acquired absence of organ
Essential hypertension
Depression
Other and unspecified alcohol dependence, unspecified drinking behavior
Pain in joint, hand
Loss of weight
Abdominal tenderness, left lower quadrant
Sleep apnea
Special screening for malignant neoplasms, colon
Encounter for screening for osteoporosis
Osteoarthritis of spine
Difficulty walking
Gout
Edema
Chronic kidney disease, stage III (moderate)
Hypertensive kidney disease, stage 1-4 or unspecified chronic kidney disease
Preoperative examination
Exophthalmos
Major depressive disorder, recurrent episode, in full remission
Brachial neuritis or radiculitis
Cervicalgia
Special screening for malignant neoplasms, colon
Primary osteoarthritis of left hip
Drug allergy
Urticaria due to drug allergy
Penicillin allergy
Hospital Course
76 F with PMH of Gout, CKD Stage 4, mild cognitive impairment and h/o of SJS presented with poor oral intake and
anorexia. Patient was found to have bilateral hazy opacities on CXR. Pulmonary was consulted and CT Chest
confirmed moderate bilateral posteriorly pleural effusions with adjacent multisegmental atelectasis. Patient received 2
units PRBC transfusion for anemia. FOBT was negative. Patient was evaluated by cardiology and was recommended
to start on Bidil and switch to IV lasix for diuresis. TSH was elevated and free T4 was WNL. Patient maintained on
synthroid 25mcg as per Endo verbal recommendations.
Patient was seen by psychiatry for medication adjustment and apetite stimulation, however, was unsuccessful. She
was seen by GI for PEG evaluation and it was planned for PEG 2/2. Patient received PEG placement without incident
on 2/2. Tube feeds started as per nutrition recs and tolerated
H.H monitored closely, 1 U PRBC administered on 2/1 for drop in H/H.
Patient had a positive UA. She was started on phenazoyridine for relief of dysuria. Urine Cx grew pseudomonas and
enterococcus, and pt was started on Aztreonam and vancomycin per ID recommendation. Pt to continue antibiotics
until 2/11/18.
Pt is stable for discharge today.
Pertinent Results:
1/28/2018
EXAMINATION: CT chest - ROUTINE - without contrast
Generated on 11/20/20 7:19 AM Page 502
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 9 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
IMPRESSION: Moderate bilateral posteriorly layering pleural effusions with adjacent multisegmental atelectasis. No
consolidation the aerated portions of the anterior lungs
LE Duplex
RIGHT: There is no evidence of deep vein thrombosis in the evaluated veins on the right.
LEFT: There is evidence of acute partially occlusive deep vein thrombosis in the proximal femoral vein.
ECHO
Severe diffuse left ventricular hypokinesis.
Severely decreased left ventricular ejection fraction.
Urine, Bacteriology Culture [1035023054] Collected:
(Abnormal) e
Lab Status: Final result Specimen: Urine
01/31/18 2318
Updated:
from See result 02/04/18 0937
narrative, above
Bacteriology Pseudomonas aeruginosa (A)
Culture, Urine
Comment:>100,000 CFU/mL
Bacteriology Enterococcus faecalis (A)
Culture, Urine
Comment:>100,000 CFU/mL
Bacteriology Enterococcus faecalis (A)
Culture, Urine
Comment:>100,000 CFU/mL
Narrative:
STRAIGHT_C:
Culture & Susceptibility
PSEUDOMONAS AERUGINOSA
Antibiotic Sensitivity MIC Unit
Cefepime Sensitive 4 mcg/mL
Method:MIC
Ciprofloxacin Sensitive <=0.5 mcg/mL
Method:MIC
Gentamicin Sensitive <=2 mcg/mL
Method:MIC
Piperacillin + Sensitive 8/4 mcg/mL
Tazobactam
Method:MIC
Tobramycin Sensitive <=2 mcg/mL
Method:MIC
ENTEROCOCCUS FAECALIS
Antibiotic Sensitivity MIC Unit
Ampicillin Sensitive 2 mcg/mL
Method:MIC
Levofloxacin Sensitive <=1 mcg/mL
Method:MIC
Generated on 11/20/20 7:19 AM Page 503
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 10 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
Nitrofurantoin Sensitive <=16 mcg/mL
Method:MIC
Tetracycline Sensitive <=0.5 mcg/mL
Method:MIC
Vancomycin Sensitive 1 mcg/mL
Method:MIC
ENTEROCOCCUS FAECALIS
Antibiotic Sensitivity MIC Unit
Ampicillin Sensitive 2 mcg/mL
Method:MIC
Levofloxacin Sensitive <=1 mcg/mL
Method:MIC
Nitrofurantoin Sensitive <=16 mcg/mL
Method:MIC
Tetracycline Sensitive <=0.5 mcg/mL
Method:MIC
Vancomycin Sensitive 1 mcg/mL
Method:MIC
Results from last 7 days
02/07/18
Lab Units
0946
WBC k/uL 8.3
HEMOGLOBIN g/dL 7.8*
HEMATOCRIT % 23.5*
PLATELET COUNT k/uL 360
Results from last 7 days
02/07/18
Lab Units
0946
SODIUM mEq/L 134*
POTASSIUM mEq/L 3.6
CHLORIDE mEq/L 98
CO2 mEq/L 21*
BUN mg/dL 46*
CREATININE mg/dL 1.54*
GFR MDRD AF AMER mL/min/BSA 40*
GFR MDRD NON-AF AMER mL/min/BSA 33*
GLUCOSE mg/dL 99
CALCIUM mg/dL 7.9*
Lab Results
Component Value Date
VANCORANDO 17.5 02/06/2018
M
Generated on 11/20/20 7:19 AM Page 504
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 11 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
Allergies:
Allergies
Allergen Reactions
•Cyproheptadine
?SJS
•Levaquin [Levofloxacin] Steven Johnson Syndrome
•Allopurinol Analogues Rash
•Colchicine Analogues Rash
•Rocephin [Ceftriaxone] Rash
Medications:
Current Facility-Administered Medications
Medication Dose Route Frequency
•acetaminophen 650 gastrostomy Q6H PRN
tablet 650 mg mg tube
• ascorbic acid 500 gastrostomy daily
(vitamin C) tablet mg tube
500 mg
•aztreonam 1 g in 1 gram intravenous Q12H
dextrose (iso-
osm) 50 mL IVPB
•bacitracin topical 1 topical daily
ointment 1 applicat
application ion
•collagenase 1 topical daily
ointment 1 applicat
application ion
•docusate 10 100 gastrostomy nightly
mg/mL oral liquid mg tube
100 mg
•enoxaparin 60 mg subcutaneous Q24AD
injection 60 mg
•ferrous sulfate 325 oral BID
tablet 325 mg mg w/meals
• folic acid tablet 1 1 mg gastrostomy daily
mg tube
• furosemide tablet 40 mg gastrostomy daily
40 mg tube
•isosorbide 20 mg gastrostomy Q8H
dinitrate tablet 20 tube
mg
•hydrALAZINE 35 mg oral Q8H
tablet 25 mg
And
• levothyroxine 25 gastrostomy daily before
tablet 25 MCG MCG tube brkfst
•mirtazapine tablet 22.5 gastrostomy nightly
22.5 mg mg tube
Generated on 11/20/20 7:19 AM Page 505
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 12 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Discharge Summary (continued)
• multivitamin 1 gastrostomy daily
(HEXAVITAMIN) tablet tube
tablet 1 tablet
•polyethylene 17 gastrostomy daily
glycol 3350 oral gram tube
powder packet 17
gram
•senna tablet 2 2 gastrostomy nightly
tablet tablet tube
• zinc sulfate 220 gastrostomy daily
capsule 220 mg mg tube
The primary reason for admission status is improving.
Discharge Disposition
Skilled Nursing Facility:Workmen's circle
Follow-up for Post-Discharge Provider:
-Continue Aztreonam 1gm BID and Vancomycin by level till 2/11/18. Please check vanco level tomorrow 2/8/18
-Follow up with your doctor in 1wk at the facility
-C/W LMWH for DVT treatment
Diet:Novasource renal 45ml/hr x20hrs. 150 free water q6hrs via PEG. Give oral supplements Breeze TID and snacks
TID.
Activities:No restrictions
Electronically signed by Eriko Kida, PA at 2/7/2018 3:35 PM
Electronically signed by Clyde H Weissbart, MD at 2/10/2018 1:57 PM
Version 7 of 8
Author: Eriko Kida, PA Service: Internal Medicine Author Type: Physician Assistant
Filed: 2/7/2018 3:20 PM Date of Service: 1/30/2018 11:09 AM Creation Time: 1/30/2018 11:09 AM
Status: Cosign Needed Editor: Eriko Kida, PA (Physician Assistant)
Cosign Required: Yes Cosigner: —
INPATIENT DISCHARGE SUMMARY
Primary Care Physician at Discharge: Mentor Sejdiu, MD
Admission Date: 1/25/18 Discharge Date: 02/07/18
Generated on 11/20/20 7:19 AM Page 506
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020
NYSCEF DOC.BATES
NO. 84 13 WAKEFIELD 3 NORTH
600 E 233rd St.
Bouknight, Rose
MRN: 01154837, DOB:
RECEIVED NYSCEF:
Sex: F
10/28/2022
Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018
01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued)
Progress Notes
Progress Notes by Marsha Wilson, RN at 1/25/2018 7:14 PM
Version 1 of 1
Author: Marsha Wilson, RN Service: — Author Type: Registered Nurse
Filed: 1/25/2018 7:15 PM Date of Service: 1/25/2018 7:14 PM Creation Time: 1/25/2018 7:15 PM
Status: Signed Editor: Marsha Wilson, RN (Registered Nurse)
Patient with healing wounds to coccyx skin intact.
Electronically signed by Marsha Wilson, RN at 1/25/2018 7:15 PM
Progress Notes by Jaisy Panangadan, RN at 1/25/2018 7:32 PM
Version 1 of 1
Author: Jaisy Panangadan, RN Service: — Author Type: Registered Nurse
Filed: 1/25/2018 7:32 PM Date of Service: 1/25/2018 7:32 PM Creation Time: 1/25/2018 7:32 PM
Status: Signed Editor: Jaisy Panangadan, RN (Registered Nurse)
Patient has got a bed on 5th floor and is ready to be transferred.
Electronically signed by Jaisy Panangadan, RN at 1/25/2018 7:32 PM
Progress Notes by Mary Skehan, RN at 1/26/2018 2:28 PM
Version 1 of 1
Author: Mary Skehan, RN Service: Care Management Author Type: Case Manager
Fil
Preview
FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC. NO. 84 RECEIVED NYSCEF: 10/28/2022 Exhibit G FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 1 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) Author: Mounica Yanamandala, MD Service: Internal Medicine Author Type: Resident Filed: 10/22/2017 6:35 PM Date of Service: 10/22/2017 12:35 PM Creation Time: 10/22/2017 12:35 PM Status: Signed Editor: Mounica Yanamandala, MD (Resident) Cosigner: Laila Khalid, MD at 10/24/2017 11:52 AM INPATIENT DISCHARGE SUMMARY Primary Care Physician at Discharge: Mentor Sejdiu, MD Admission Date: 10/20/17 Discharge Date: 10/22/2017 Reason for Admission: SJS/TEN Presenting History: 76F h/o gout, CKD, dementia, admitted to Montefiore New Rochelle 10/15/17 for fever, AMS, LE edema, now transferred to Moses for suspected SJS/TEN. Patient AOx1 and poor historian, hx obtained from accompanying medical records. Several weeks ago, patient fell from bed and was admitted to Lawrence Hospital, discharged the next day. Upon arrival home, family noted hives and pruritic maculopapular rash throughout body, sparing palms and soles. Family concerned sxs 2/2 food allergy (tomato). PMD had started patient on cyproheptadine prior to that admission, unclear when stopped. Rash worsened, patient developed generalized weakness, was taken to St. Lukes Hospital, received unknown treatment for rash (cannot recall), IVF, symptoms improved so patient discharged to Sutton Park rehab 10/5/17. On 10/14/17, patient developed fever, daughter noticed open lesions on chest and behind right ear with purulent discharge and AMS, patient brought to New Rochelle. At New Rochelle, admitted for evaluation and treatment of desquamating skin lesions on back, chest, and behind R ear. Allopurinol stopped on admission. Affected BSA <10%, suspected SJS. R ear lesion was bleeding, patient anemic to 6.9, received 1u pRBC. Was unable to obtain dermatology consult at New Rochelle. Started on IVF for hydration, IV methylprednisolone 70mg QD, aztreonam and vancomycin IV x1. Abx dc'd after ID consulted. Skin care provided with silvadene and chlorhexidine, silvadene changed to mupirocin after WBC increased. LE doppler showed L common femoral DVT, started on therapeutic Lovenox. Guaiac positive, Lovenox held x 1 day, transfused 1u pRBC, AC restarted after Hgb stable. Skin wound cx MRSA positive, put under contact isolation. Review of labs from New Rochelle reveal peripheral eosinophilia, now resolved, leukopenia, anemia. TSH 13.89, fT4 1.08. Uric acid ~8, Cr ~1.5, Alk phos ~150, HCO3 ~18. Parvo B19 IgG pos, IgM neg, HIV neg, CMV neg. Wound cx with MRSA. CTH neg for ICH or mass effect, partial empty sella. CXR neg. Skin bx with interface dermatitis, ddx includes DRESS, fixed drug reaction, SJS/TEN, erythema multiforme. Patient transferred to Moses for dermatology evaluation. Patient states she has had this diagnosis before 2-3 years ago. Denies pain. SH: reports h/o smoking PMH: CKDIII, HTN PSH: none documented Meds: APAP 325 q6h Bacitracin ointment Generated on 11/20/20 7:20 AM Page 1216 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 2 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) Trazodone 25mg qd Lovenox 60mg qd Lasix 20mg PO qd Levothyroxine 25mcg qd Methylprednisolone 70mg IV qd Multivitamin qd Mupirocin topical ointment Pantoprazole 40mg IV q12h Vitamin D3 2000 IU Allergies: tomato, ?cyproheptadine, ?allopurinol, PCN Presenting Physical Exam: Gen: Awake and alert. NAD. AO to person, not to time or place. Skin: Numerous sloughing skin lesions on anterior chest, back, neck. + Nikolsky sign. Numerous 1cm nonblanching purpuric lesions scattered through BL LE. Minimal oozing of large anterior chest lesion. HEENT: Anicteric sclerae. No mucosal lesions noted. PERRL. CV: RRR, 2/6 systolic murmur at apex. Resp: Bibasilar crackles. Abd: Soft, NT/ND. BS present. No rebound or guarding. Ext: No pedal edema. 2+ DP pulses BL. Diagnoses: Hospital Problems Hospital * (Principal)SJS-TEN overlap syndrome (Chronic) Non-Hospital Problem Non-Hospital Stevens-Johnson syndrome (Chronic) Routine general medical examination at a health care facility Special screening for malignant neoplasms, colon Other screening breast examination Hyperlipidemia Other malaise and fatigue Tobacco use disorder Other acquired absence of organ Essential hypertension Depression Other and unspecified alcohol dependence, unspecified drinking behavior Pain in joint, hand Loss of weight Abdominal tenderness, left lower quadrant Sleep apnea Special screening for malignant neoplasms, colon Encounter for screening for osteoporosis Osteoarthritis of spine Difficulty walking Gout Edema Chronic kidney disease, stage III (moderate) Hypertensive kidney disease, stage 1-4 or unspecified chronic kidney disease Preoperative examination Generated on 11/20/20 7:20 AM Page 1217 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 3 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) Exophthalmos Major depressive disorder, recurrent episode, in full remission Brachial neuritis or radiculitis Cervicalgia Special screening for malignant neoplasms, colon Primary osteoarthritis of left hip Drug allergy Urticaria due to drug allergy Penicillin allergy Hospital Course Patient with a greater than 1 week history of desquamating rash, dusky violaceous papules and plaques, and eosinophilia. Lesions involve close to 30% of her body surface area without any mucosal or genital involvement. Patient was transferred from New Rochelle to Montefiore Moses for dermatology evaluation due to concern for SJS/TEN. Dermatology evaluated patient, and obtained a fresh frozen skin sample from central upper chest. Based on their evaluation, there is clinical concern for SJS/TEN or DRESS, and recommended that patient be transferred to the Jacobi Burn Unit for further evaluation. Patient was started on steroids at New Rochelle; however, without significant improvement in skin lesions. Dermatology recommended tapering down of steroids. She was initially on methylprednisolone 70 mg daily, and is now currently receiving methylprednisolone 40 mg daily. Dermatology recommending use of IVIG 3 gm/kg/day. Nephrology was consulted to assist with choosing IVIG that would be least nephrotoxic. They recommend IVIG (Gamunex-C) which would be the least nephrotoxic, and should be given at the lowest rate possible and with hydration. As patient is being transferred to Jacobi, will defer starting until patient arrives there. With regards to patient's DVT, she was noted to have a left common femoral DVT at New Rochelle and was started on therapeutic lovenox. She had some oozing at skin sites, and was noted to be guaiac positive (though no melena was noted). She received 1U PRBC. Hemoglobin has been stable during hospitalization at Montefiore, and lovenox was continued. Of note, patient's Cr has been rising during hospitalization from 1.1 to 1.6. Would consider changing lovenox to heparin. Also, skin wound culture MRSA positive, put under contact isolation. Patient's family members were contacted and notified of her transfer to Jacobi. Son is Kevin Lynch at 874-303-1979 and sister is Delores Harris at 914-319-0129. Pertinent Results: Results from last 7 days 10/22/17 10/20/17 Lab Units 0408 2232 WBC k/uL 5.3 3.9* HEMOGLOBIN g/dL 9.2* 8.4* PLATELET COUNT k/uL 305 223 Results from last 7 days 10/22/17 10/20/17 Lab Units 0408 2232 SODIUM mEq/L 143 142 POTASSIUM mEq/L 5.6* 5.5* Generated on 11/20/20 7:20 AM Page 1218 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 4 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) CHLORIDE mEq/L 112* 113* CO2 mEq/L 15* 13* BUN mg/dL 39* 37* CREATININE mg/dL 1.60* 1.40 GLUCOSE mg/dL 86 104 CALCIUM mg/dL 8.3* 8.5 MAGNESIUM mg/dL 2.0 -- PHOSPHORUS mg/dL 5.0* -- No results found for: BNP No results found for: TROPONINT Results from last 7 days 10/22/17 10/20/17 Lab Units 0408 2232 AST U/L 35 42 ALT U/L 32* 23 ALK PHOS U/L 135 171* BILIRUBIN TOTAL mg/dL 1.0 0.7 BILIRUBIN DIRECT mg/dL 0.2 0.3 PROTEIN TOTAL g/dL 4.9* 5.2* ALBUMIN g/dL 1.9* 2.3* Procedures & Surgeries DERM PATH (10/19/17) . Skin, site unspecified, biopsy (2 slides labeled RS1704683 1-1 and 1-2): - INTERFACE DERMATITIS. Note: The differential diagnosis includes a drug reaction, disseminated fixed drug reaction, or drug rash with eosinophilia with systemic symptoms (DRESS). The findings could also be seen in the erythema multiforme -Stevens-Johnsonsyndrome-toxic epidermal necrolysis spectrum of diseases. Clinicopathological correlation is necessary. Physical Exam at Discharge: Gen: patient lying in bed, generalised tremors, conversant, says feels improved Resp: CTAB CVS: s1 and s2 audible Abd: soft non-tender Skin: lesion on eyelid, none around mouth, neck (desquamating), multiple small lesions on the back, some are desquamating; likely covering 10-30% of the skin area Genital exam: no lesions noted Allergies: Allergies Allergen Reactions •Cyproheptadine ?SJS •Levaquin [Levofloxacin] Steven Johnson Syndrome •Allopurinol Analogues Rash Generated on 11/20/20 7:20 AM Page 1219 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 5 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) •Colchicine Analogues Rash •Rocephin [Ceftriaxone] Rash Medications: Current Facility-Administered Medications Medication Dose Route Frequency •acetaminophen 32 975 mg oral once mg/mL oral liquid 975 mg •acetaminophen tablet 650 mg oral Q6H PRN 650 mg •chlorhexidine 4 % topical topical Q12H liquid •dextrose 5 % and sodium 1,000 mL intravenous continuous chloride 0.45 % infusion •enoxaparin injection 80 1 subcutaneous Q24AD mg mg/kg/DO SE •levothyroxine 25 MCG in 25 MCG intravenous daily NS (20 mcg/mL) IV syringe •methylPREDNISolone 40 mg intravenous daily sodium succinate 40 mg/mL injection 40 mg •mupirocin 2 % ointment topical Q8H Immunizations given during hospitalization The primary reason for admission status is deteriorated. Discharge Disposition Acute Care Hospital Follow-up for Post-Discharge Provider: 1. Continue to taper down steroids 2. Start IVIG per dermatology recommendations 3. Monitor renal function 4. Likely switch from enoxaparin to heparin ggt 5. IV hydration Outpatient Follow-Up Future Appointments Date Time Provider Department Center Barry 12/30/ 8:40 Southeast Fomberstein, BXERHEUM 2017 AM Br MD Test Results Pending at Discharge Generated on 11/20/20 7:20 AM Page 1220 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 6 MOSES NW4W 111 East 210 Street Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore Bronx NY 10467-2401 Admission: 10/20/2017, Discharge: 10/22/2017 10/20/2017 - Admission (Discharged) in MOSES NW4W (continued) Discharge Summary (continued) Order Current Status SURGICAL PATHOLOGY TEST In process SURGICAL PATHOLOGY TEST In process Electronically signed by Mounica Yanamandala, MD at 10/22/2017 6:35 PM Electronically signed by Laila Khalid, MD at 10/24/2017 11:52 AM Version 2 of 3 Author: Mounica Yanamandala, MD Service: Internal Medicine Author Type: Resident Filed: 10/22/2017 1:51 PM Date of Service: 10/22/2017 12:35 PM Creation Time: 10/22/2017 12:35 PM Status: Shared Editor: Mounica Yanamandala, MD (Resident) Cosign Required: Yes Cosigner: — INPATIENT DISCHARGE SUMMARY Primary Care Physician at Discharge: Mentor Sejdiu, MD Admission Date: 10/20/17 Discharge Date: 10/22/2017 Reason for Admission: SJS/TEN Presenting History: 76F h/o gout, CKD, dementia, admitted to Montefiore New Rochelle 10/15/17 for fever, AMS, LE edema, now transferred to Moses for suspected SJS/TEN. Patient AOx1 and poor historian, hx obtained from accompanying medical records. Several weeks ago, patient fell from bed and was admitted to Lawrence Hospital, discharged the next day. Upon arrival home, family noted hives and pruritic maculopapular rash throughout body, sparing palms and soles. Family concerned sxs 2/2 food allergy (tomato). PMD had started patient on cyproheptadine prior to that admission, unclear when stopped. Rash worsened, patient developed generalized weakness, was taken to St. Lukes Hospital, received unknown treatment for rash (cannot recall), IVF, symptoms improved so patient discharged to Sutton Park rehab 10/5/17. On 10/14/17, patient developed fever, daughter noticed open lesions on chest and behind right ear with purulent discharge and AMS, patient brought to New Rochelle. At New Rochelle, admitted for evaluation and treatment of desquamating skin lesions on back, chest, and behind R ear. Allopurinol stopped on admission. Affected BSA <10%, suspected SJS. R ear lesion was bleeding, patient anemic to 6.9, received 1u pRBC. Was unable to obtain dermatology consult at New Rochelle. Started on IVF for hydration, IV methylprednisolone 70mg QD, aztreonam and vancomycin IV x1. Abx dc'd after ID consulted. Skin care provided with silvadene and chlorhexidine, silvadene changed to mupirocin after WBC increased. LE doppler showed L common femoral DVT, started on therapeutic Lovenox. Guaiac positive, Lovenox held x 1 day, transfused 1u pRBC, AC restarted after Hgb stable. Skin wound cx MRSA positive, put under contact isolation. Review of labs from New Rochelle reveal peripheral eosinophilia, now resolved, leukopenia, anemia. TSH 13.89, fT4 1.08. Uric acid ~8, Cr ~1.5, Alk phos ~150, HCO3 ~18. Parvo B19 IgG pos, IgM neg, HIV neg, CMV neg. Wound cx with MRSA. CTH neg for ICH or mass effect, partial empty sella. CXR neg. Skin bx with interface dermatitis, ddx includes DRESS, fixed drug reaction, SJS/TEN, erythema multiforme. Patient transferred to Moses for dermatology evaluation. Patient states she has had this diagnosis before 2-3 years Generated on 11/20/20 7:20 AM Page 1221 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 7 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) Author: Eriko Kida, PA Service: Internal Medicine Author Type: Physician Assistant Filed: 2/7/2018 3:35 PM Date of Service: 1/30/2018 11:09 AM Creation Time: 1/30/2018 11:09 AM Status: Signed Editor: Eriko Kida, PA (Physician Assistant) Cosigner: Clyde H Weissbart, MD at 2/10/2018 1:57 PM INPATIENT DISCHARGE SUMMARY Primary Care Physician at Discharge: Mentor Sejdiu, MD Admission Date: 1/25/18 Discharge Date: 02/07/18 Reason for Admission: Failure to thrive and Anorexia Presenting History: 76 Y old F from Workmen's Circle NH with PMH of Gout, CKD stage 4 , mild cognitive impairment, h/o of SJS treated with high dose steroids. Patient presented with poor oral intake, refusing to eat for above a year now and patient has lost around 100 lbs in a year. Nothing makes it better or worse. Per son Mr Kevin Lynch, Tel: 864-303-1979, Patient has been refusing to eat for a year now and that this has been worsening since October 2017 when the patient was receiving the treatment for a suspected SJS secondary to severe drug allergy. Son has tried everything to enhance her appetite and only noticed mild improvement at few times. When asked the patient, she mentioned that she doesn't like the taste of food presented to her and that she doesn't feel like eating and that she is feeling depressed recently but she denies any feeling of helpless ness or hopelessness, any suicidal or death ideas but reported difficulty sleeping, also she denies any mistreatment from her family, saying that they come and visit her regularly. No Chest pain, SOB, Nausea, vomiting, abdominal pain, diarrhea, leg swelling, dysuria. Presenting Physical Exam: Constitutional: Well developed, well nourished, in no acute distress. Skin: Patchy healed dark pigmented skin lesions in her face, lower extremity and her back. Eyes:No ptosis, conjunctivae clear, sclerae anicteric, PERRL, EOMI. Exophthalmos is noted bilaterally . Pulmonary/Chest: Clear to auscultation; no crackles, rhonchi, or wheezing. Cardiovascular: Regular rate and rhythm with no murmurs, rubs or gallops. Abdominal: Normal bowel sounds, soft, non-tender and non-distended without masses, organomegaly.. Diagnoses: Hospital Problems Hospital Failure to thrive (0-17) Non-Hospital Problem Non-Hospital Stevens-Johnson syndrome (Chronic) SJS-TEN overlap syndrome (Chronic) Routine general medical examination at a health care facility Generated on 11/20/20 7:19 AM Page 501 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 8 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) Special screening for malignant neoplasms, colon Other screening breast examination Hyperlipidemia Other malaise and fatigue Tobacco use disorder Other acquired absence of organ Essential hypertension Depression Other and unspecified alcohol dependence, unspecified drinking behavior Pain in joint, hand Loss of weight Abdominal tenderness, left lower quadrant Sleep apnea Special screening for malignant neoplasms, colon Encounter for screening for osteoporosis Osteoarthritis of spine Difficulty walking Gout Edema Chronic kidney disease, stage III (moderate) Hypertensive kidney disease, stage 1-4 or unspecified chronic kidney disease Preoperative examination Exophthalmos Major depressive disorder, recurrent episode, in full remission Brachial neuritis or radiculitis Cervicalgia Special screening for malignant neoplasms, colon Primary osteoarthritis of left hip Drug allergy Urticaria due to drug allergy Penicillin allergy Hospital Course 76 F with PMH of Gout, CKD Stage 4, mild cognitive impairment and h/o of SJS presented with poor oral intake and anorexia. Patient was found to have bilateral hazy opacities on CXR. Pulmonary was consulted and CT Chest confirmed moderate bilateral posteriorly pleural effusions with adjacent multisegmental atelectasis. Patient received 2 units PRBC transfusion for anemia. FOBT was negative. Patient was evaluated by cardiology and was recommended to start on Bidil and switch to IV lasix for diuresis. TSH was elevated and free T4 was WNL. Patient maintained on synthroid 25mcg as per Endo verbal recommendations. Patient was seen by psychiatry for medication adjustment and apetite stimulation, however, was unsuccessful. She was seen by GI for PEG evaluation and it was planned for PEG 2/2. Patient received PEG placement without incident on 2/2. Tube feeds started as per nutrition recs and tolerated H.H monitored closely, 1 U PRBC administered on 2/1 for drop in H/H. Patient had a positive UA. She was started on phenazoyridine for relief of dysuria. Urine Cx grew pseudomonas and enterococcus, and pt was started on Aztreonam and vancomycin per ID recommendation. Pt to continue antibiotics until 2/11/18. Pt is stable for discharge today. Pertinent Results: 1/28/2018 EXAMINATION: CT chest - ROUTINE - without contrast Generated on 11/20/20 7:19 AM Page 502 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 9 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) IMPRESSION: Moderate bilateral posteriorly layering pleural effusions with adjacent multisegmental atelectasis. No consolidation the aerated portions of the anterior lungs LE Duplex RIGHT: There is no evidence of deep vein thrombosis in the evaluated veins on the right. LEFT: There is evidence of acute partially occlusive deep vein thrombosis in the proximal femoral vein. ECHO Severe diffuse left ventricular hypokinesis. Severely decreased left ventricular ejection fraction. Urine, Bacteriology Culture [1035023054] Collected: (Abnormal) e Lab Status: Final result Specimen: Urine 01/31/18 2318 Updated: from See result 02/04/18 0937 narrative, above Bacteriology Pseudomonas aeruginosa (A) Culture, Urine Comment:>100,000 CFU/mL Bacteriology Enterococcus faecalis (A) Culture, Urine Comment:>100,000 CFU/mL Bacteriology Enterococcus faecalis (A) Culture, Urine Comment:>100,000 CFU/mL Narrative: STRAIGHT_C: Culture & Susceptibility PSEUDOMONAS AERUGINOSA Antibiotic Sensitivity MIC Unit Cefepime Sensitive 4 mcg/mL Method:MIC Ciprofloxacin Sensitive <=0.5 mcg/mL Method:MIC Gentamicin Sensitive <=2 mcg/mL Method:MIC Piperacillin + Sensitive 8/4 mcg/mL Tazobactam Method:MIC Tobramycin Sensitive <=2 mcg/mL Method:MIC ENTEROCOCCUS FAECALIS Antibiotic Sensitivity MIC Unit Ampicillin Sensitive 2 mcg/mL Method:MIC Levofloxacin Sensitive <=1 mcg/mL Method:MIC Generated on 11/20/20 7:19 AM Page 503 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 10 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) Nitrofurantoin Sensitive <=16 mcg/mL Method:MIC Tetracycline Sensitive <=0.5 mcg/mL Method:MIC Vancomycin Sensitive 1 mcg/mL Method:MIC ENTEROCOCCUS FAECALIS Antibiotic Sensitivity MIC Unit Ampicillin Sensitive 2 mcg/mL Method:MIC Levofloxacin Sensitive <=1 mcg/mL Method:MIC Nitrofurantoin Sensitive <=16 mcg/mL Method:MIC Tetracycline Sensitive <=0.5 mcg/mL Method:MIC Vancomycin Sensitive 1 mcg/mL Method:MIC Results from last 7 days 02/07/18 Lab Units 0946 WBC k/uL 8.3 HEMOGLOBIN g/dL 7.8* HEMATOCRIT % 23.5* PLATELET COUNT k/uL 360 Results from last 7 days 02/07/18 Lab Units 0946 SODIUM mEq/L 134* POTASSIUM mEq/L 3.6 CHLORIDE mEq/L 98 CO2 mEq/L 21* BUN mg/dL 46* CREATININE mg/dL 1.54* GFR MDRD AF AMER mL/min/BSA 40* GFR MDRD NON-AF AMER mL/min/BSA 33* GLUCOSE mg/dL 99 CALCIUM mg/dL 7.9* Lab Results Component Value Date VANCORANDO 17.5 02/06/2018 M Generated on 11/20/20 7:19 AM Page 504 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 11 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) Allergies: Allergies Allergen Reactions •Cyproheptadine ?SJS •Levaquin [Levofloxacin] Steven Johnson Syndrome •Allopurinol Analogues Rash •Colchicine Analogues Rash •Rocephin [Ceftriaxone] Rash Medications: Current Facility-Administered Medications Medication Dose Route Frequency •acetaminophen 650 gastrostomy Q6H PRN tablet 650 mg mg tube • ascorbic acid 500 gastrostomy daily (vitamin C) tablet mg tube 500 mg •aztreonam 1 g in 1 gram intravenous Q12H dextrose (iso- osm) 50 mL IVPB •bacitracin topical 1 topical daily ointment 1 applicat application ion •collagenase 1 topical daily ointment 1 applicat application ion •docusate 10 100 gastrostomy nightly mg/mL oral liquid mg tube 100 mg •enoxaparin 60 mg subcutaneous Q24AD injection 60 mg •ferrous sulfate 325 oral BID tablet 325 mg mg w/meals • folic acid tablet 1 1 mg gastrostomy daily mg tube • furosemide tablet 40 mg gastrostomy daily 40 mg tube •isosorbide 20 mg gastrostomy Q8H dinitrate tablet 20 tube mg •hydrALAZINE 35 mg oral Q8H tablet 25 mg And • levothyroxine 25 gastrostomy daily before tablet 25 MCG MCG tube brkfst •mirtazapine tablet 22.5 gastrostomy nightly 22.5 mg mg tube Generated on 11/20/20 7:19 AM Page 505 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 12 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Discharge Summary (continued) • multivitamin 1 gastrostomy daily (HEXAVITAMIN) tablet tube tablet 1 tablet •polyethylene 17 gastrostomy daily glycol 3350 oral gram tube powder packet 17 gram •senna tablet 2 2 gastrostomy nightly tablet tablet tube • zinc sulfate 220 gastrostomy daily capsule 220 mg mg tube The primary reason for admission status is improving. Discharge Disposition Skilled Nursing Facility:Workmen's circle Follow-up for Post-Discharge Provider: -Continue Aztreonam 1gm BID and Vancomycin by level till 2/11/18. Please check vanco level tomorrow 2/8/18 -Follow up with your doctor in 1wk at the facility -C/W LMWH for DVT treatment Diet:Novasource renal 45ml/hr x20hrs. 150 free water q6hrs via PEG. Give oral supplements Breeze TID and snacks TID. Activities:No restrictions Electronically signed by Eriko Kida, PA at 2/7/2018 3:35 PM Electronically signed by Clyde H Weissbart, MD at 2/10/2018 1:57 PM Version 7 of 8 Author: Eriko Kida, PA Service: Internal Medicine Author Type: Physician Assistant Filed: 2/7/2018 3:20 PM Date of Service: 1/30/2018 11:09 AM Creation Time: 1/30/2018 11:09 AM Status: Cosign Needed Editor: Eriko Kida, PA (Physician Assistant) Cosign Required: Yes Cosigner: — INPATIENT DISCHARGE SUMMARY Primary Care Physician at Discharge: Mentor Sejdiu, MD Admission Date: 1/25/18 Discharge Date: 02/07/18 Generated on 11/20/20 7:19 AM Page 506 FILED: WESTCHESTER COUNTY CLERK 10/28/2022 01:55 PM INDEX NO. 64205/2020 NYSCEF DOC.BATES NO. 84 13 WAKEFIELD 3 NORTH 600 E 233rd St. Bouknight, Rose MRN: 01154837, DOB: RECEIVED NYSCEF: Sex: F 10/28/2022 Monte lore BRONX NY 10466-2604 Admission: 1/25/2018, Discharge: 2/7/2018 01/25/2018 - ED to Hosp-Admission (Discharged) in WAKEFIELD 3 NORTH (continued) Progress Notes Progress Notes by Marsha Wilson, RN at 1/25/2018 7:14 PM Version 1 of 1 Author: Marsha Wilson, RN Service: — Author Type: Registered Nurse Filed: 1/25/2018 7:15 PM Date of Service: 1/25/2018 7:14 PM Creation Time: 1/25/2018 7:15 PM Status: Signed Editor: Marsha Wilson, RN (Registered Nurse) Patient with healing wounds to coccyx skin intact. Electronically signed by Marsha Wilson, RN at 1/25/2018 7:15 PM Progress Notes by Jaisy Panangadan, RN at 1/25/2018 7:32 PM Version 1 of 1 Author: Jaisy Panangadan, RN Service: — Author Type: Registered Nurse Filed: 1/25/2018 7:32 PM Date of Service: 1/25/2018 7:32 PM Creation Time: 1/25/2018 7:32 PM Status: Signed Editor: Jaisy Panangadan, RN (Registered Nurse) Patient has got a bed on 5th floor and is ready to be transferred. Electronically signed by Jaisy Panangadan, RN at 1/25/2018 7:32 PM Progress Notes by Mary Skehan, RN at 1/26/2018 2:28 PM Version 1 of 1 Author: Mary Skehan, RN Service: Care Management Author Type: Case Manager Fil