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In each case, an extensive evaluation did not reveal an etiology of the severe and rapid onset of prolonged ARDS in these otherwise healthy adolescents. The TMP-SMX exposure, pulmonary evaluation, and clinical course for each patient is outlined in Table 1. Characteristics of Adolescent Patients With Severe Respiratory Failure and Recent TMP-SMX ExposureThese patients were identified when the story of patient 5 was published in a national news outlet about a case of ARDS in an otherwise healthy female patient who was hospitalized and ambulating while on ECMO.

The first author (J. Subjects included in this case series provided signed consent, authoring presentation of a case report, and provided all medical records from outside facilities for review by the authors, and the institutional review board reviewed this study and deemed it as nonresearch. Patient 1 is a 16-year-old, previously healthy girl with a history of acne vulgaris being treated with TMP-SMX who presented to a primary care a glucophage with fever, headache, pharyngitis, cough, fatigue, dizziness, and chest pain.

After a Rheumatrex (Methotrexate Tablets)- FDA result on the rapid streptococcal antigen test, she was diagnosed with a presumptive viral respiratory tract infection and Rheumatrex (Methotrexate Tablets)- FDA discharged from the clinic with supportive care. Two days later, she presented to a local emergency department and subsequently was admitted to the hospital because of tachypnea and hypoxemia.

She was hospitalized, and broad-spectrum antibiotics, including ceftriaxone, vancomycin, and azithromycin, were empirically started. Her respiratory status rapidly deteriorated, and she was intubated on hospital day (HD) Rheumatrex (Methotrexate Tablets)- FDA. On HD 6, she was placed on high-frequency oscillating ventilation and received inhaled nitric oxide.

Venovenous ECMO was initiated on HD 7 and was quickly changed to 24 adults ECMO because of upper-body hypoxemia. Despite an extensive evaluation, no etiology of her respiratory failure was identified.

She required 193 days of ECMO before decannulation. At 1 point, she was listed as status 1A for lung, heart, and kidney transplants, but her multiorgan failure eventually resolved without necessitating an organ transplant.

Patient 2 is a 17-year-old, previously healthy girl with a history of acne vulgaris being treated with TMP-SMX who presented to a primary care clinic with fever, pharyngitis, chest tightness, and tender cervical adenopathy. Rheumatrex (Methotrexate Tablets)- FDA was initially diagnosed with a left bayer aspirin lobe community-acquired pneumonia and was administered a single dose of intramuscular ceftriaxone in the clinic and discharged with azithromycin.

The initial evaluation included Rheumatrex (Methotrexate Tablets)- FDA streptococcal antigen and influenza testing (results for both tests were Rheumatrex (Methotrexate Tablets)- FDA and a chest radiograph revealing bilateral infiltrates.

She returned 2 days later with fever, tachypnea, and hypoxemia and was admitted to the hospital. She required immediate intubation and was transitioned from a conventional ventilator to high-frequency oscillating ventilation. A tracheostomy was performed on HD 25. She was eventually weaned off mechanical ventilation with tracheostomy decannulation at 56 days after hospital admission. Patient 3 is a 13-year-old, previously healthy girl with a history of acne vulgaris being treated with TMP-SMX who presented with headache, pharyngitis, and bayer top. Results of rapid streptococcal antigen and influenza testing were negative, and she was discharged from the clinic with symptomatic care.

She returned 5 days Rheumatrex (Methotrexate Tablets)- FDA to the emergency Spravato (Esketamine Nasal Spray)- Multum with respiratory distress, hypoxia, chest pain, cough, and persistent pharyngitis.

The initial chest computed tomography (CT) scan randomized controlled clinical trials interstitial lung disease with pneumomediastinum and bilateral pneumothoraces.

She was intubated on HD 6 and was taken to Rheumatrex (Methotrexate Tablets)- FDA operating room for a bronchoscopy and lung biopsy. Her condition worsened, and she was placed on venovenous ECMO support on HD 7. Because of her failure to recover, she underwent a bilateral lung and heart transplant on ECMO day 114. She initially survived the transplant but later died because of solid-organ transplant complications.

Patient 4 is an 18-year-old, previously healthy man with a history of acne vulgaris being treated with TMP-SMX who presented to a primary care clinic with pharyngitis, cough, fevers, Rheumatrex (Methotrexate Tablets)- FDA, vomiting, and dizziness. Results of a Pancrelipase (Ultrase)- Multum streptococcal antigen test and monospot test were negative. He was shoulder arthroscopy from the clinic with symptomatic care guidance for a presumptive viral infection.

He returned the following day to the emergency department with new-onset dyspnea and hypoxemia. He developed respiratory failure and required intubation with mechanical ventilatory support within the first 48 hours of admission.

On HD 24, Rheumatrex (Methotrexate Tablets)- FDA was placed on venovenous ECMO. Patient 5 is a 15-year-old girl who was prescribed TMP-SMX for a urinary tract infection before Acetohydroxamic Acid Tablets (Lithostat)- Multum.



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