Clinical Challenge: Cough, Fever, in Person Who Vapes

Clinical Challenge: Cough, Fever, in Person Who Vapes

A 16-year-old adolescent presents to the emergency department with a 3-day history of vomiting, tactile fevers, and a mild headache that went away 2 days earlier.  The patient denies any abdominal or flank pain, dysuria, diarrhea, or other complaints. When specifically questioned, she acknowledges a slight cough but has no shortness of breath or chest pain.  

Vital Signs and Physical Examinations

The patient’s vital signs are normal except for an elevated temperature (100.3 °F) and a pulse rate 133 beats per minute. Initial physical examination is otherwise normal with no rash, tonsillar exudate, rales, murmur, flank tenderness, or other abnormality. Chest radiographs (Figure 1-2) and blood work are ordered. Laboratory results are within normal range except for an elevated white blood cell count (19,000/μL). Pregnancy and COVID-19 PCR tests are negative.

Figure 1 and 2. Chest radiographs taken at the time of admission to the emergency department show subtle bilateral interstitial infiltrates. <I> Credit: Brady Pregerson, MD</I>

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Source: Medical Bag

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