Case 4
A 16-year-old white male presented with 6 days of fever to 39.2°C (102.6°F), cough, shortness of breath, vomiting, and diarrhea. He was prescribed albuterol, azithromycin, and prednisone prior to admission, but was unable to adhere to treatment due to vomiting. On admission, he had lymphopenia; elevated CRP, PCT, and ESR. His SARS-CoV-2 PCR testing was negative. His FRVP, anti-streptolysin O, fungal antibody panel, histoplasma serum and urine antigens, QuantiFERON TB Gold plus, and sputum fungal and mycobacterial cultures were negative. A chest CT showed multifocal ground-glass opacities bilaterally. He was empirically started on ceftriaxone and azithromycin. He required supplemental oxygen until day 6 of admission. He initially acknowledged marijuana usage but denied vaping, later clarifying usage of E-cigarettes. He was started on steroids and after significant clinical improvement was discharged home on day 8 of hospitalization. He remained asymptomatic during the outpatient follow up.