Discussed is the case of a 13-year-old male with no significant past medical history, who presented to the hospital for evaluation of multisystem inflammatory syndrome in children (MIS-C). He arrived with findings of conjunctivitis, strawberry tongue, tachycardia at rest, and hypoxemia with oxygen saturation of 85%. The patient was recently hospitalized 1 week prior for viral pneumonia and hypoxemia due to SARS-CoV-2. During his inpatient stay he received combination therapy of remdesivir and dexamethasone. Following, he weaned to room air and his pulse oximetry (SaO2) order was switched to intermittent with floor vitals prior to his discharge.

Acute respiratory distress syndrome (ARDS) is a disabling and potentially lethal syndrome requiring prompt recognition and urgent interventions to prevent morbidity and mortality[1]. Although constipation is not generally recognized as a cause for ARDS or usually listed within the differential diagnosis, there have been case reports describing such an association[2,3]. We present the case of a patient with history of intermittent constipation presenting with progressive abdominal pain and an acute abdomen that required emergent surgical fecal decompaction. This was followed by hypoxemic respiratory distress leading to respiratory failure in the setting of severe constipation and aspirated feculent material. To our knowledge, this is the first published case report describing aspirated feculent material in a child with respiratory failure due to ARDS.