A 22-year-old man with fevers, chills, and a non-productive cough

Abstract

A 22-year-old man with bipolar disorder and anxiety presented with fevers, chills, nausea, vomiting, and a non-productive cough for four days. He reported a fever up to 40°C at home and an inability to tolerate oral intake for approximately two days. His cough was dry and not associated with sputum production or hemoptysis. He endorsed headaches and diarrhea as associated symptoms. He reported a significant tetrahydrocannabinol (THC) and nicotine vaping history, which included the use of two nicotine cartridges and one THC cartridge daily. His last use was approximately 1 week prior to presentation. He denied neck pain and stiffness, leg swelling, dysuria, and abdominal pain. There was no personal or family history of thromboembolism. His home medications, taken daily, included lamotrigine and escitalopram. He had no recent travel history or sick contacts. The patient lived in a college dormitory in a major U.S. city. He had no pets or recent contact with birds. He denied any known exposure to heavy metals, agricultural chemicals, or any dyes, foams, and resins. The patient had also never been exposed to toxic gases such as chlorine. It should be noted that this patient presented to the hospital for care approximately four months before the first U.S. case of COVID-19, and as such, this is not investigated as part of the work-up. Physical examination findingsHis temperature was 37.8°C, blood pressure 140/ 65 mmHg, heart rate 102 beats/min, respirations 22 breaths/min, and oxygen saturation 90% on room air. He was well-developed and in no acute distress with decreased bilateral breath sounds in the lower lung fields on auscultation but no audible wheezes, rales, or rhonchi. His cardiovascular exam was unremarkable except for tachycardia. His abdomen was soft, nontender, and nondistended with normoactive bowel sounds. There was no peripheral edema.