A 21-year-old woman gasped when she read the headline. “16-year-old girl walks on life support and eats tacos” She scanned an article about a girl who had a mysterious lung-destroying disease and needed a machine to help her breathe. “I need to do something,” she said to herself after she finished writing her article.She knew what was killing this girl. she believed there was.
At the time, she was a senior in high school and a starting member of the women’s volleyball team. A few days into her new semester, she developed her 103-degree fever and sore throat. Her River, Minnesota She lives in the small town of Falls Her doctor thinks she has some kind of viral infection and predicts she will feel better with a few days of rest Did. he was wrong The fever subsided, but she was replaced by the most severe fatigue the girl had ever experienced. Just getting out of her bed made her gasp. Her mother took her to her nearest emergency room, 25 miles away.
When the nurse checked the young woman’s vital signs, she looked surprised. The patient’s oxygen saturation, which is normally well over her 90%, was dangerously low in her 60s. A nurse put an oxygen mask over her nose and mouth and reached out to her doctor. Her chest X-ray showed a gray cloud encroaching on her lungs. A few minutes later, she rode an ambulance to her Sanford Medical Center in Fargo, North Dakota. Sanford Medical Center is the closest hospital with a pediatric intensive care unit.
At Fargo, she was started on several broad-spectrum antibiotics. The doctors there didn’t know which bug was causing this pneumonia, but until they found out, they figured these antibiotics should protect her. , had to be put on a respirator for a few days.
When that wasn’t enough, Sanford’s doctors contacted the Mayo Clinic in Rochester, Minnesota. Eight days after she entered her ER, the patient’s lungs were barely functioning. The next step was a heart-lung machine familiar to her as ECMO, which stands for extracorporeal membrane oxygenation. The refrigerator-sized device acts as the lungs, which removes carbon dioxide waste products from the blood and replaces it with oxygen, and acts as the heart, which recirculates oxygenated blood throughout the body. Her ECMO team at the Mayo Clinic flew to Fargo with the machine, attached the young woman to the device, and returned with her to the Mayo Her Clinic hospital. That machine breathed for her for the next 116 days.
month of transplant list
Like the girl in the article, she was walking while attached to a giant machine. She’s not a taco either, but she was eating on the machine. The first thing to pass her lips was a communion wafer. She finally felt good enough to walk at least part of the way to the hospital chapel surrounded by a team of doctors, nurses and technicians. I didn’t understand why it was gone. She spent months on her transplant list, waiting for new hearts and lungs to replace those doctors thought would never recover. But they did. After seven months in the hospital, I was finally able to go home.
Over the next few years, she returned to Mayo every six months for check-ups. During those visits, she would always stop by the pediatric intensive care unit and see a nurse who had become a second family to her in the months when she was nearing her death. One day, two years after she was hospitalized, some nurses told her about a child with a disease very similar to hers.
A few hours later, she and her parents met with the child’s parents and told them the story of their 12-year-old daughter’s lungs failing after what appeared to be a viral illness. Families compared the notes to see if there were any similarities in the lives and exposures of the two children. They lived in different rural and urban settings in different parts of the state. Nothing seemed to match, but trimethoprim-sulfamethoxazole ( TMP-SMX). The young lady gasped.She was on this antibiotic (to treat acne in her case) – until the day she went to the ER.
Since then, another family has contacted her with a familiar story. A healthy, active young man was near death when his lungs were damaged enough to require life support. She asked these parents if their son was taking her TMP-SMX when he got sick. Yes, I got a surprise reply. There were 3 cases in total. You may have found a real connection.
And now there was this young woman in the news. Her name is Zey Ouwadia. The article names Dr. Jenna Miller as a pediatric ICU specialist at Children’s Her Mercy Hospital in Kansas City, Missouri. He was taking care of Ouwadia. The young woman found her address in the doctor’s email and immediately sent a note. “I started taking Bactrim about three to four weeks before my acne treatment,” she said. [my] Acute lung failure,” she wrote. “This has happened to at least three children between the ages of 12 and 20. [old]…the similarities between our cases are striking. She asked if Owadia was on TMP-SMX as well.
same unusual pattern
Miller was astonished. Indeed, she was on TMP-SMX when she got sick. Miller reached out to her friend Dr. Jennifer Goldman, a pediatrician trained in infectious diseases and clinical pharmacology. She continued her research into the drug’s side effects for years. TMP-SMX is an effective, safe and inexpensive drug, and as such is her sixth most prescribed antibiotic in the country. It may be a coincidence that these four of her, a small fraction of the millions taking this drug on any given day, became ill. Still, doctors agreed to investigate. Two pediatricians collected the medical records of the patient who sent the email and other cases she discovered. All were healthy young men who developed devastating lung damage after a brief flu-like illness, often with fever, sore throat, or cough. And all were taking her TMP-SMX.
It was a biopsy of the affected lung that convinced doctors of the link. Each exhibited the same anomalous pattern of intensively destroyed. The only cells in the lungs that were affected were those that had taken up carbon dioxide and were supplied with oxygen. This is the cell that performs the most important work of respiration. In two, including the patient who first pointed out the link between her disease and the drug, these essential cells eventually grew and were able to breathe on their own again. of people needed a lung transplant. Of these initial cases, two died. A young woman is her 12-year-old girl whom she met in Mayo, and her Uwadia, a news story girl.
In the four years since Miller received the patient’s email, she and Goldman identified a total of 19 patients, most under the age of 20, who exhibited this response after treatment with TMP-SMX. Six people died. It’s still unclear how antibiotics cause this rare but devastating destruction. Goldman believes it’s most likely an allergic reaction of some sort. But who is at risk and why is still unpredictable.
As an ICU physician, Miller says he uses the drug frequently. These cases are rare, but the devastation they cause is terrible. “Most of these people were not being treated for life-threatening illnesses, but were given this common medicine.
This former patient shares Miller’s mixed feelings. She is now 26 and a nurse caring for a patient who has just had a heart-lung transplant. She regularly administers her TMP-SMX to patients. And they need it—to treat the ailments they have and prevent the ones they might get. I know my lungs will never be the same. Still, she lives a good life. And she’s proud of what she’s contributed to her science, and one day she hopes to make sure this doesn’t happen to anyone else.
Lisa Saunders, M.D., is a contributing writer for the magazine. Her latest book is Diagnosis: Solving the Most Baffling Medical Mysteries. If you have a resolved case to share, please email Lisa.Sandersmdnyt@gmail.com.
