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Her Lungs Mysteriously Shut Down. How Could This Have Happened?

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The 21-year-old woman gasped as she read the headline: “The 16-Year-Old Girl Who Walks and Eats Tacos While on Life Support.” She scanned the article about a girl who had a mysterious illness that destroyed her lungs and who now needed a machine to breathe for her. “I need to do something,” she told herself once she finished the article. She believed she knew what was killing this young girl, because the story could have been her own, six years earlier.

Back then, she was a high school junior on the starting lineup of the girls’ volleyball team. Just days into the new school year, she developed a 103-degree fever and sore throat. Her doctor, in tiny Thief River Falls, Minn., figured she had some type of viral infection and predicted she would feel better after a few days of rest. He was wrong. The fever resolved but was replaced with the most profound fatigue the girl had ever known. Just getting out of bed left her breathless. Her mother took her to the nearest emergency room, 25 miles away.

As the nurse checked the young woman’s vital signs, she looked alarmed. The patient’s oxygen saturation, which would normally be well over 90 percent, was in the 60s, dangerously low. The nurse slapped an oxygen mask over her nose and mouth and reached out to the doctor in charge. A chest X-ray showed a gray cloud invading her lungs. Minutes later she was in an ambulance headed for the Sanford Medical Center in Fargo, N.D., the closest hospital with a pediatric intensive-care unit.

In Fargo she was started on several broad-spectrum antibiotics. The doctors there didn’t know which bug was causing this pneumonia, but until they did, they figured these antibiotics should protect her. But she continued to worsen, and within days needed to be put on a ventilator.

When even that wasn’t enough, the doctors at Sanford contacted the Mayo Clinic in Rochester, Minn. Eight days after she walked into the E.R., the patient’s lungs were hardly working at all. The next step was an artificial-heart-and-lung machine known familiarly as ECMO — short for extracorporeal membrane oxygenation. This device, about the size of a refrigerator, acts as a lung to remove the carbon-dioxide waste product from the blood and replace it with oxygen and then as a heart to recirculate the oxygenated blood back through the body. The ECMO team from the Mayo Clinic flew out to Fargo with their machine, attached the young woman to the device and flew back with her to the Mayo Clinic Hospital. That machine breathed for her for the next 116 days.

Like the girl in the article, she, too, had walked while connected to the massive machine. She, too, had eaten while on the machine, though not tacos. The first thing to pass her lips was a communion wafer when she finally felt well enough to walk at least part of the way to the hospital chapel surrounded by a squad of doctors, nurses and technicians. They never figured out why her lungs failed. She spent months on the transplant list, waiting for a new heart and lungs to replace the ones her doctors thought would never recover. But they did. And finally, after seven months in the hospital, she was able to go home.

For a few years afterward she returned to Mayo every six months for a checkup. During those visits, she always stopped by the pediatric intensive-care unit to see the nurses who had become a second family to her in the months she hovered near death. At one visit, two years after her own time in the hospital, several nurses told her about a child whose illness seemed remarkably like her own.

Hours later she and her parents met with this child’s parents, who told the story of their daughter, just 12 years old, whose lungs had simply stopped working after what looked like a viral illness. The families compared notes to see if there were any similarities between the two children’s lives and exposures. They lived in different environments — one rural, one urban — in different parts of the state. Nothing seemed to match, until finally the child’s parents reported that in the weeks before coming to the hospital, their daughter had been taking an antibiotic: trimethoprim-sulfamethoxazole (TMP-SMX), known under the brand name Bactrim. The young woman gasped. She had been taking this antibiotic (in her case to treat acne) — right up to the day she went to the E.R.

Since then, another family contacted her with a familiar story: A healthy, active adolescent gets desperately sick, with lungs so damaged that he needed life support. She asked these parents if their son was taking TMP-SMX when he got sick. Yes, came the amazed reply. That made a total of three cases. Maybe she had found a real connection.

And now there was this young woman in the news. Her name was Zei Uwadia. The article named Dr. Jenna Miller as the pediatric I.C.U. specialist at Children’s Mercy Hospital in Kansas City, Mo., who was taking care of Uwadia. The young woman found an email address for the doctor and immediately sent her a note. “I began taking Bactrim for acne about 3-4 weeks prior to [my] acute lung failure,” she wrote. “This happened to at least 3 children between 12-20 years [old]. … The similarities between our cases are uncanny.” She asked if Uwadia had been taking TMP-SMX too.

Miller was astonished. Indeed, the girl was taking TMP-SMX when she got sick. Could there be a link? Miller reached out to a friend, Dr. Jennifer Goldman, who was a pediatrician trained in infectious disease and clinical pharmacology. She had been doing research on adverse reactions to this drug for years. TMP-SMX is an effective, safe and inexpensive drug and, because of that, is the sixth-most-prescribed antibiotic in the country. It could be a coincidence that these four people, a tiny fraction of the millions on this medicine on any given day, got sick. Still, the doctors agreed that they should investigate. The two pediatricians collected the medical records of the patient who sent the email and the other cases she had found. All were healthy young people who developed a devastating lung injury after a brief flulike illness often with a fever, sore throat or cough. And all had taken TMP-SMX.

What convinced the doctors that there was a link were the biopsies of the affected lungs. Each showed the same unusual pattern of focused destruction: The only cells within the lung that were affected were those in which carbon dioxide was taken up and oxygen supplied — the cells that do the most important work of breathing. In two, including the patient who first noted the connection between her illness and the drug, these essential cells eventually grew back, allowing them to once again breathe on their own. Others whose lung tissue did not recover needed a lung transplant. Of those first cases, two died: the 12-year-old that the young woman met at Mayo and Uwadia, the girl in the news story.

In the four years since Miller received the patient’s email, she and Goldman have identified a total of 19 patients, most under age 20, who had this reaction after being treated with TMP-SMX. Six died. It is still unclear how the antibiotic triggers this rare but devastating destruction. Goldman thinks it is probably some kind of allergic reaction. But they still cannot predict who is at risk, or why.

As an I.C.U. doctor, Miller tells me, she uses this drug frequently. And although these cases are rare, the devastation caused is terrible. “Most of these people,” she says, referring to the 19 cases, “were not getting treated for a life-threatening illness, and yet they were given this ordinary drug — and it ended their life or changed it forever.”

This original patient shares Miller’s mixed feelings. She is 26 now and is a nurse who cares for patients who have just had a heart-and-lung transplant. She regularly gives her patients TMP-SMX. And they need it — to treat diseases they have and to prevent diseases they might get. Yet she knows that, because of her reaction to that drug, her lungs will never be the same. She can play a friendly game of volleyball but gets winded after climbing a couple flights of stairs. Still, she has a good life. And she is proud to have made a contribution to the science that she hopes will, one day, prevent this from happening to anyone else.


Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmdnyt@gmail.com.

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Love Letter: A Mysterious Delivery

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After Charlotte Maya lost her husband to suicide, she and her young sons were used to unexpected visitors. But when her doorbell rang one mid-December evening, nobody was there.

Instead, on her doormat was a kit to make a gingerbread house with a note that only said, “On the First Day of Christmas. … ”

In this week’s Modern Love essay, “When a Doorbell’s Ring Means Hope,” Ms. Maya describes how a series of mysterious deliveries buoyed her family during their darkest days.

Join the 7-Day Happiness Challenge.

Research shows that the single most important driver of happiness is the strength of our relationships. Sign up for a week of exercises from the New York Times Well desk that will help set you up for a happier, more connected year.

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How One Japanese-American Designer Is Revitalizing Vintage Kimonos

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In her Brooklyn studio, designer Sara Sakanaka keeps a small drawstring bag that her grandmother made for her decades ago. Sewn from textile scraps, the striped pouch is one of Sakanaka’s oldest keepsakes, an heirloom representing a generations-old philosophy. “My mom used to tell me this story. It was about how if we treat objects with love and care for one hundred years, they can obtain a soul,” she shares as pours each of us a cup of Mugicha, a Japanese Barley tea that she grew up drinking. We met at her studio on a gray Tuesday morning, where a collection of silk separates, each made from reclaimed Japanese kimonos, hangs neatly. On a shelf, folded piles of salvaged textiles wait for her to sew them into something new, just like her grandmother once did as a hobby. “There’s this whole idea that objects have lives,” she says. “I like to see every piece as a true considered object in that way.” 

Nick Krasznai / courtesy of Considered Objects 

It makes sense then that Sakanaka would name her own label Considered Objects. The 39-year-old launched her line—a collection of hand-sewn jackets, dresses, and shirtings that are made entirely from reclaimed Japanese kimonos and textiles—just two years ago. “I never had the dream of starting a business,” she shares. “I was happy working toward someone else’s vision. But at some point, there’s this part of you that wants to explore what you want to say. It took time for me to be able to discover that.” 

Sakanaka has a lot to say. With 20 years of experience under her belt, she has developed a design philosophy of her own. “I have no interest in buying new materials or producing with mills,” she says while showing me the intricate, hand-stitched panels of a vintage summer kimono. As she points out its cotton lining and hand-painted family crests (her own paternal and maternal family crests are tattooed on each of her arms), it becomes clear that she is not just making clothing; she’s stitching age-old stories into contemporary garments. “After years of working at different fashion brands, I found that you can get stuck on this hamster wheel. What has always grounded me was the question, ‘how can I not only find true meaning in these things, but how can I offer connection through these pieces?’”

Nick Krasznai / courtesy of Considered Objects 

Nick Krasznai / courtesy of Considered Objects 

An FIT graduate, the apparel designer previously worked for fashion label Imitation of Christ, luxury line Ports 1961, bespoke womenswear collection Honor, and the Japanese fashion house Foxey. In 2020, after spending nearly four years traveling back and forth between New York and Japan for work, she felt she was ready for something new. “I started to wonder how I would mentally, physically, and creatively sustain. I was burnt out.” she tells me. Around that time, her grandmother, the one who gave her the collaged drawstring bag and taught her how to sew, passed away. “This was during the pandemic, so I wasn’t able to attend her funeral in Japan. I had previously inherited her collection of kimonos and rediscovered them during that time. I had completely forgotten about them, but learning about them became part of my grieving process. Having those made me feel close to her,” Sakanaka reflects. 

It was then that she took a page from her grandmother’s book. “Studying these shambled garments and giving them new life through reconstruction was a way for me to heal while reconnecting with myself and my culture,” she says. Preserving the original rectangular panels and stitching style from each kimono, the designer began dismantling and reassembling each one. Her first design? A classic, collared, button-down shirt. Inside each shirt she constructed, Sakanaka sewed a layered patchwork flower made from leftover silk scraps. “That flower, that mark, it was sort of my way of memorializing the whole experience of my creation and of finding closure. It was a way of bestowing my honor upon each piece.” 

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Here’s How to Style 5 Luxurious Loungewear Sets This Winter

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All products featured on Vogue are independently selected by our editors. However, we may earn affiliate revenue on this article and commission when you buy something.

Cozying up for the winter has never looked chicer courtesy of luxurious loungewear sets from The Row, Wardrobe.NYC, Éterne, and more. Crafted from ultra-soft cashmeres and sultry silks, these matching sets are as indulgent as it gets and can be worn in the comfort of your own home or out and about for casual coolness. As the newly appointed foundation of your winter wardrobe, styling a luxe loungewear set properly can offer both ease and elegance at the same time. 

For an elevated errand ensemble, The Row’s ‘Jaspar’ hoodie and matching ‘Anton’ wide-leg pants are knitted from the softest of cashmere. The chic combination is so comfortable that you won’t want to change once you get home. Enhance the look with stylish sneakers from Nike, plush cable-knit socks from Johnstons of Elgin, and Nothing Written’s minimalist bag. Loungewear sets, like this cashmere turtleneck and midi skirt pairing from Altuzarra, also have the power to be dressed up for festive evenings out, especially when adorned in jewels from Missoma and Laura Lombardi. A matching activewear set from Sporty & Rich ensures that you arrive at any workout in style. Sofa-ready outfits from Wardrobe.NYC and Olivia Von Halle help curate the perfect night in this holiday season and beyond. 

This winter, investing in a loungewear set has never looked better. Below, here are five ways to style luxe loungewear sets that are as comfortable as they are chic. (Plus, also find a few more statement sets to add to your winter wardrobe.) 

The Elegant Errand Runner

Nothing says chic errand runner like this matching cashmere hoodie and pant set from The Row. Knitted from the softest of cashmere, it’s a chic combination so comfortable that you won’t want to change once you get home. Enhance the look with stylish sneakers from Nike, plush cable-knit socks from Johnstons of Elgin, and Nothing Written’s minimalist bag. Jewels from Mejuri are welcome embellishments. 

The Row Jaspar cashmere hoodie

The Row Anton cashmere high-rise pants

Johnstons of Elgin cable-knit cashmere socks

Nothing Written Ferry bag

Mejuri bold Croissant dôme huggies

The Cozy, Yet Chic Evening Look 

A loungewear set doesn’t have to be confined to the comforts of your own home or even resemble a traditional sweatsuit, for that matter. Case in point: find this dazzling skirt set from Altuzarra that is crafted from pure cashmere. Complete the elegant evening ensemble with Saint Laurent’s croc-effect pumps and Anine Bing’s minimalist handbag. Drip in gold thanks to Missoma hoop earrings and Laura Lombardi’s cult-classic necklace. 

Saint Laurent Blade chain croc-effect leather slingback pumps

Anine Bing Colette shoulder bag

Missoma x Lucy Williams chunky entwine hoop earrings

Laura Lombardi Calle gold-plated necklace

The Statement Sporty Attire

When it comes to activewear, a matching set, like this one from Sporty & Rich, will ensure that you arrive at any workout in style. Go one step further and tie the brand’s ‘Wellness’ sweatshirt around your waist for extra comfort. New Balance ‘Core’ sneakers are a staple in any workout wardrobe, as are these Bala Bangles and Stanley’s tumbler to keep you nice and hydrated. 

Sporty & Rich appliquéd cotton-jersey sweatshirt

Sporty & Rich cropped printed stretch-jersey tank

Sporty & Rich printed stretch-jersey leggings

New Balance 574 Core sneakers

Stanley Quencher H2.O travel tumbler, 40oz

The Luxurious Loungewear Set

Wardrobe.NYC x Hailey Bieber’s simple grey sweatshirt and sweatpants are prime examples of luxurious loungewear. Wear with a coveted pair of Birkenstocks—or even heels for an elevated athleisure look. But because we’re sticking with loungewear, cozy up even more courtesy of cashmere socks from Raey and Brunello Cucinelli’s alpaca-blend blanket. Loewe’s scented candle is an immediate ambiance enhancer. 

Wardrobe.NYC x Hailey Bieber cotton sweatshirt

Wardrobe.NYC x Hailey Bieber wide-leg cotton sweatpants

Birkenstock Boston shearling clogs

Raey ribbed cashmere-blend socks

Brunello Cucinelli speckled-jacquard fringed alpaca-blend blanket

Loewe Home Scents Honeysuckle medium scented candle, 610g

The Perfect Pair of Pajamas 

Olivia Von Halle’s ‘Coco’ pajama set is crafted from the finest of satins to create a soft-to-the-touch feel you’ll never want to take off. Meanwhile, Ugg slippers are the perfect accoutrement. Continue to wind down with the help of scented bath salts from Maude and Augustinus Bader’s luxurious face cream. Reflect on your day with The Five Minute Journal and finally get some shut-eye thanks to Brooklinen’s silk eye mask. 

Olivia Von Halle Coco silk-satin pajama set

Ugg Scuffette II slippers

Brooklinen Mulberry silk eyemask

Augustinus Bader The Rich Cream with TFC8® face moisturizer

Maude Soak No. 2 nourishing mineral bath salts

Shop More: 

Leset Lauren cropped stretch-knit cardigan

Leset Lauren stretch-knit wide-leg pants

Éterne oversized crewneck sweatshirt

Éterne classic sweatpants

Lisa Yang Jonny cap-sleeved cashmere sweater

Lisa Yang Sierra wide-leg cashmere trousers

Zara basic hoodie sweatshirt

Girlfriend Collective ReSet cropped stretch recycled top

Girlfriend Collective compressive stretch recycled flared leggings

Le Kasha Etretat organic cashmere sweater

Le Kasha Sumbal cashmere wide-leg pants

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