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.