Case 3
An 18-year-old white male presented with 1 week of persistent tactile
fevers, chest pain, shortness of breath, vomiting, and diarrhea after
two days of outpatient therapy with azithromycin and levofloxacin. Upon
admission, ceftriaxone was started, and levofloxacin was continued.
Initial laboratory work-up showed lymphopenia, elevated CRP, PCT, and
LDH. His FRVP and SARS-CoV-2 PCR were negative. Fungal antibody panel,
blood and urine histoplasma antigens and urine Legionella antigen were
negative. He reported frequent use of marijuana and vaping. A CT of the
chest showed multifocal airspace disease with relative subpleural
sparing. A bronchoalveolar lavage (BAL) was performed with negative
cultures for bacterial, mycobacterial, and fungal etiologies. BALPneumocystis jirovecii PCR was positive with negative stains or
signs of eosinophilic pneumonia on cytology. He clinically improved with
improved inflammatory markers without the need for supplemental oxygen.
He was discharged after 3 days.