Abstract | November 17, 2023
E-Cigarette or Vaping Use-Associated Lung Injury in a Nicotine Dependent Male with COVID-19
Learning Objectives
- Upon completion of this lecture, learners should be better prepared to discuss the differential diagnosis of EVALI based on recent e-cigarette or vaping use, acute symptom onset, signs of inhalational lung injury on imaging in the absence of alternative lung diagnosis.
- Upon completion of this lecture, learners should be better prepared to recognize a potential treatment combination of steroids for lung inflammation and hypoxemia, smoking cessation aids for substance use, and antibiotics in case of any possible infection, for EVALI patients.
Introduction: E-cigarette or vaping use-associated lung injury (EVALI) is a novel and severe respiratory condition characterized by lung inflammation due to inhaled substances. Given its overlap in presentation with other pulmonary conditions, the diagnosis can easily be overlooked.
Case Presentation: A 22-year-old Hispanic man with a history of tobacco use disorder presented with one day of shortness of breath, non-productive cough, and fever. Symptoms started after he inhaled vape pen oil. He was unvaccinated for COVID-19. Vitals at presentation were notable for a temperature of 100.5°F, blood pressure of 149/90, heart rate of 145/min, respiratory rate of 50-60 per minute, and 87% O2 saturation on 9L nasal cannula. On exam, he appeared anxious and had clear lungs to auscultation bilaterally. Labs were remarkable for SARS-COV2 positive, elevated WBC (26,500/mm3) with left shift and normal procalcitonin. Chest X-Ray revealed ill-defined bibasilar opacities accompanied by a right pleural effusion. Chest CT Angiogram (CTA) was negative for pulmonary embolism (PE) but significant for numerous airways centered nodules more prominent on the right lung and moderate pulmonary edema. Diagnosis of EVALI was made based on the constellation of acute symptoms, the close temporal relationship of vaping use with presentation, and lower suspicion for infection on imaging and lab values. Other main differential diagnoses included pneumonia secondary to COVID-19, community-acquired pneumonia, and PE, but were excluded based on negative workup including a normal procalcitonin level and absence of PE on CTA.
Final Diagnosis: EVALI
Management and Outcome: During hospitalization, the patient was empirically treated for community-acquired pneumonia (ceftriaxone/azithromycin), COVID (remdesivir), and EVALI with prednisone 60mg daily. The patient rapidly improved over the course of hospitalization with resolved hypoxia and was discharged on day 4 on steroid taper.
References and Resources
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