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. Credit: Brady Pregerson, MD

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Can you diagnose this condition? What is the most important medical history question to ask?

  1. Do you vape?
  2. Any injection drug use?
  3. Any recent air travel?
  4. Any new sexual partners?

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Case Studies
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General Pulmonology