A 19-Year-Old With Hemoptysis and Shortness of Breath

A 19-year-old woman with no medical history who did not use tobacco presented to the hospital with post-COVID-19 cough for 2 months and new onset of shortness of breath and blood-tinged sputum. She was initially treated empirically for community-acquired pneumonia because her chest radiograph showed a right upper lobe infiltrate. Further CT scan imaging revealed a right hilar lymph node conglomerate and extensive lymphadenopathy. The patient left to pursue care at a facility that accepted her insurance. Two weeks later, the patient presented for severe left-sided lower back pain, and she was found to have new complete left lower lobe collapse, likely because of extrinsic compression of the left lower lobe bronchus. She was treated for pain, and she left for insurance reasons. Two months later, the patient presented with progressive shortness of breath and hemoptysis and a 23-kg weight loss over the past 4 months. Because of the patient's increasing medical needs, she was transferred to our institution, where she was admitted to the medical ICU.