Case 1
A 16-year-old white male presented with 4 days of fevers to 38.7°C
(101.4°F), nausea, severe abdominal pain, diarrhea, cough, and dyspnea.
He denied any known exposure to COVID-19 infected individuals. He was
admitted due to his tachypnea and concerns of MIS-C. Shortly after
admission, he developed worsening tachypnea and hypoxia, along with
difficulty breathing on nasal cannula requiring transitioning to high
flow nasal cannula oxygen on second day of admission. Laboratory workup
was remarkable for lymphopenia, elevated erythrocyte sedimentation rate
(ESR), C-reactive protein (CRP), procalcitonin (PCT), ferritin, and
lactate dehydrogenase (LDH). Chest X-Ray showed bibasilar interstitial
infiltrates. Chest computed tomography (CT) revealed bilateral
multifocal ground-glass opacities (Figure 1). Nasopharyngeal (NP)
SARS-CoV-2 PCR and serum antibodies were negative twice. FilmArray®
respiratory panel (FRVP) (Biofire Defense, Salt Lake City, Utah) was
negative. He remained febrile, with ongoing respiratory distress despite
empiric therapy with ceftriaxone and azithromycin. He later disclosed
vaping every week with products obtained from his friends. Urine drug
screen was positive for tetrahydrocannabinol (THC). Intravenous steroids
were started due to suspected EVALI. He was weaned to room air within 48
hours, his infiltrates improved on repeat chest X-ray. He was discharged
after 8 days of hospital stay.