6105 ‘Severe para influenza type 3 infection leading to respiratory failure and shock in a vaping adolescent with c3 deficiency: a case report’

Objectives The objectives of this case report are to highlight the alarming rise in teenage e-cigarette usage and its association with e-vaping Associated Lung Injury( EVALI). It also emphasizes the severity and rapid progression of simple viral infections in the vaping adolescents. Methods (1) Case Report: the methodology was outlining the patient's history, clinical presentation, diagnostic tests, administered treatments, and overall case management along with literaturereview. The goal was to offer a thorough insight into the distinctive aspects of the patient's situation. (2) Background; In recent years, the alarming surge in teenage e-cigarette usage, known as vaping, has raised concerns due to its association with E vaping associated Lung Injury (EVALI)1 – a severe pulmonary illness caused by the inhalation of aerosolized toxic substances.2 As of February 2020, EVALI led to over 2,500 hospital admissions and 68 reported deaths, including 15% among individuals under 18 years of age.3 Compelling evidence links tobacco and flavoring compounds in vaping devices to EVALI, lung cancer, and cardiovascular and cerebrovascular health issues.4 Case Presentation; This case report centers on a 13-year-old girl referred to our Pediatric Assessment Unit by a local GP. Her initial symptoms included cough, chest pain, sore throat, headache, and high fever, which were initially attributed to Lower Respiratory Tract Infection (LRTI) and gastroenteritis. Unexpectedly, her condition deteriorated rapidly, resulting in respiratory failure and shock within a span of four hours. A chest X-ray revealed bilateral patchy opacification and left lobar consolidation. Laboratory results indicated elevated white cell count, neutrophil count, CRP, creatinine, and INR levels. Aggressive resuscitation measures, including adrenaline infusion and non-invasive respiratory ventilation, were initiated before transferring her to a Pediatric Intensive Care Unit (PICU) at a tertiary care hospital. Subsequent investigations unveiled a history of daily vaping for one year. While a Para Influenza Type 3 infection was confirmed through nasopharyngeal swab testing, her symptoms were consistent with EVALI, including respiratory and gastrointestinal symptoms, respiratory failure, shock, bilateral patchy opacities, marked leukocytosis, and elevated inflammatory markers. The girl has an underlying complement component 3 deficiency, which mainly causes severe recurrent bacterial infections with encapsulated gram negative organisms. Results The patient was recovered after one week of treatment from EVALI and returned home. There are no numeric results/data available on this. Conclusion In conclusion, this case underscores the critical need to address vaping habits in children and teenagers and emphasizes the importance of early detection of EVALI by healthcare providers. Prolonged vaping in our patient likely contributed to pre-existing lung injury, which resulted from recurrent upper and lower respiratory tract infections due to her underlying primary immunodeficiency. The Para Influenza virus acted as a trigger for respiratory failure and shock References Layden JE, Ghinai I, Pray I, et al. Pulmonary illness related to E-cigarette use in illinois and wisconsin - final report. N Engl J Med 2020. Cancers, Shehata SA, Toraih EA, Ismail EA, et al. Vaping, environmental toxicants exposure, and lung cancer risk. 2023. Centers for Disease Control and Prevention (CDC). Outbreak of Lung Injury Associated with the Use of E-C Blount BC, Karwowski MP, Morel-Espinosa M, et al. Morbidity and Mortality Weekly Report (MMWR), 2019