A teenager with type 1 diabetes and rapidly progressive respiratory failure

Rapid progression to fulminant ARDS

A teenager with type 1 diabetes presents with rapidly progressive respiratory failure. Requiring BiPAP, then intubation SIMV-PS, APRV, then oscillator. There’s no history of drug use, huffing, no new medications, or industrial or environmental exposures. He has a one-week history of prodrome diarrhea, cough, fevers, and hyperglycemia. An infection work-up has been negative (HIV, PJP, BAL and blood cultures, viral PCR, CMV, fungal cultures and PCR). No eosinophils on BAL. No improvement with pulse steroids, antibiotics, antivirals, or antifungals. What do you think is the cause?

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