Case 5
A 17-year-old white male presented with 7 days of cough and 4 days of fever to 39.4°C (103°F), myalgias, and fatigue with emesis. On admission he had mild respiratory distress requiring nasal cannula oxygen. A chest X-ray showed bilateral lung opacities. Azithromycin and ceftriaxone were empirically started. His initial laboratory workup was remarkable for leukocytosis, elevated ESR, CRP, and LDH. SARS-CoV-2 PCR was obtained twice and negative. in both opportunities, His FRVP and SARS-CoV-2 antibodies were negative. Legionella urine antigen, M. pneumoniae throat PCR, histoplasma urine and blood antigens, EBV profile, HIV ELISA, and QuantiFERON TB-gold plus were negative. Later he acknowledged E-cigarette and marijuana usage. A THC urine test that was positive. CT of the chest showed diffuse bilateral ground-glass opacities, with regions of superimposed interlobular septal thickening. Antibiotic treatment was discontinued. He was started on steroids with significant improvement in 24 hours and was subsequently discharged.