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.