Abstract Introduction The prevalence of E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) is rising. EVALI is an emerging cause of acute respiratory failure, with presentations ranging from mild pneumonitis to severe acute respiratory distress syndrome (ARDS). We present a case of EVALI leading to acute eosinophilic pneumonia (AEP) in a young woman presenting with respiratory failure. Case Presentation A 20-year-old woman with a history of asthma presented with one day of dyspnea, cough, and pleuritic chest pain. Vital signs were notable for sinus tachycardia and hypoxemia on room air (SpO2 91%). Chest imaging showed patchy opacities at the lung bases. Laboratory evaluation revealed leukocytosis (WBC 43.23 × 10³/μL, 92% neutrophils). She reported occasional cigarette use and tetrahydrocannabinol vaping. Over the subsequent eleven hours, her oxygen requirements continued to increase as she progressed from nasal cannula to high-flow oxygen, ultimately requiring intubation for worsening refractory hypoxemia. Despite optimized ventilator management and proning, P/F ratio was 61 with marked acidosis (ABG pH 7.11 PaC02 70 Pa02 61). She was placed on Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) and transferred to Hackensack University Medical Center for advanced respiratory support. Bronchoalveolar lavage (BAL) revealed marked eosinophilia (60%) and was positive for a non-COVID coronavirus. Infectious workup was otherwise negative. Broad spectrum antibiotics were discontinued and moderate dose methylprednisone was continued. There was rapid improvement in lung compliance and clearing on serial imaging. She was weaned off ECMO on day 6, extubated on day 8, and was weaned to room air by day 9. She left the hospital on day 13 with no residual respiratory symptoms. She was discharged on prednisone 1 mg/kg daily and tapered off over 6 weeks with no recurrence of symptoms. Discussion This report describes a young adult who developed severe ARDS and AEP following recent vaping. The diagnosis was supported by her exposure history, radiographic findings, BAL eosinophilia, and her rapid improvement with corticosteroids. Early bronchoscopy and timely initiation of steroids, together with VV-ECMO support, were crucial to her recovery. EVALI is a form of acute lung injury with multiple reported associated pathologies. Acute eosinophilic pneumonia has only rarely been reported as a manifestation of EVALI, though it has also been described in association with viral pneumonias. EVALI was suspected in this case given the lack of other AEP triggers. This case highlights the need to consider eosinophilic pneumonia for patients with acute lung injury and a history of vaping. This abstract is funded by: None
Yogeswaran et al. (Fri,) studied this question.