Case 4
A 17 year-old male with depression, and history of illicit drug use was
transferred to our hospital from an outside institution due to worsening
respiratory distress. He initially presented with 10 days of fever and
harsh, dry cough. Patient has a history of vaping nicotine and THC
multiple times a day for past 5 years. He was prescribed azithromycin
for community acquired pneumonia by Urgent Care prior to presentation to
our hospital. Symptoms continued to worsen, and the patient presented to
emergency room with increased respiratory rate and hypoxemia, with pulse
oximetry reading of 84% on room air. Chest x-ray showed bilateral
interstitial opacities, elevated fibrinogen >1000 mg/dL,
D-dimer 2457 ng/mL C-reactive protein (CRP) 35.6 mg/dL and erythrocyte
sedimentation rate (ESR) 83 mm/hr . Hydroxychloroquine was given for 2
days for presumed COVID-19 pneumonia. This was discontinued when
multiple nasopharyngeal SARS-CoV-2 RT-PCR tests returned negative. At
the outside hospital, his respiratory support escalated to a maximum
requirement of nasal cannula 55L, and FiO2 of 50% and upon transfer, he
was intubated for respiratory failure. Repeat Nasopharyngeal SARS CoV-2
RT-PCR testing, which was again negative. Methylprednisolone was started
to treat the EVALI. He was extubated on hospital day 12 and was
discharged with no supplemental oxygen on hospital day 19.