Emergency Medicine Resident

Teenager with rapidly progressive respiratory failure. Only PMH type 1 diabetes. No drug use or huffing. 1 wk prodrome diarrhea, cough, fevers and hyperglycemia. Rapid progression to fulminate ARDS. Req BiPAP, then intubation SIMV-PS, APRV then oscillator. All infection work up negative (HIV, PJP, BAL and blood cultures, viral PCR, CMV, fungal cultures and PCR). No eosinophils on BAL. No new drug, industrial or environmental exposures. No improvement with pulse steroids, antibiotics, antivirals or antifungals. Only improvement after proning. Eventually extubated after oscillator for > 1 week.