Case 2
A 17 year old male with history of Attention Deficit Hyperactivity Disorder presented with fever(to a maximum of 102.7F) and shortness of breath for 5 along with 3 weeks of cough, congestion and rhinorrhea. He was previously treated with 2 days of amoxicillin by his primary care doctor. Vital signs upon presentation to the ED were temperature of 100.4, Pulse rate of 142 beats per min. Respiratory rate of 22 breaths per minute a blood pressure of 126/70 and pulse oximetry showed a room air saturation of 91% . Chest x-ray showed bibasilar infiltrates and CT scan showed multifocal opacities throughout the lung. There were no known COVID-19 exposures. He admitted to vaping every other day for a year with occasional using Tetrahydrocannabinol (THC) vaping pen. Infectious workup was significant for a negative nasopharyngeal swab for SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) , a negative Respiratory viral panel (RT PCR) test, a positive mycoplasma IgM but the confirmatory Immunofluorescent assay later reported negative. Laboratory workup was revealing for elevated Prothrombin time (PT) 21.3 sec, Partial Thromboplastin Time (PTT) 40 sec and international normalized ratio (INR) 1.86 sec, Procalcitonin 0.37 mg/mL, D-Dimer 1115 ng/mL and Ferritin 529 ng/m(normal values in Table 1 footnotes). Hydroxychloroquine was initially started for presumed COVID-19 infection and the patient received 2 doses, before COVID-19 test results were available. Once COVID was ruled out on hospital day 2, Methylprednisolone was started to treat the EVALI. Five days of Azithromycin and 1 day of Levofloxacin were used as well to treat a possible mycoplasma infection. Vitamin K was used to treat the coagulopathy. During his 6 day hospital stay a maximum of 4L nasal cannula at 30 percent Fi02 was required and he was weaned to room air on hospital day 5.