Abstract Introduction E-cigarette or vaping product use-associated lung injury (EVALI) is an acute or subacute respiratory illness characterized by severe lung injury from inhaling aerosols generated by vaping devices, which heat substances such as nicotine and cannabinoids. The exact cause remains unclear, but vitamin E acetate and tetrahydrocannabinol (THC) are implicated in most cases. Patients often present with respiratory and gastrointestinal symptoms, and diagnosis requires exclusion of infections and other lung diseases. Case Report A 21-year-old male with no past medical or surgical history presented with shortness of breath for 1 day. He had been smoking heavily for the last 8-10 days, including 1-2 packs of cigarettes daily as well as heavy vaping. Initially, he required 2 L of oxygen via nasal cannula and subsequently required BiPAP support. A chest CT angiogram performed at the referring facility showed non-cardiogenic pulmonary edema consistent with possible ARDS. Given the initial suspicion of pneumonia, he was treated with intravenous antibiotics including vancomycin, cefepime, and azithromycin. Despite treatment, the patient’s acute hypoxic respiratory failure worsened, necessitating intubation and initiation of ARDS protocol. He had worsening bilateral mixed pulmonary opacities on repeat chest X-ray despite being on antibiotics. Chest CT revealed mixed interstitial and ground-glass opacities throughout both lungs with moderate bilateral pleural effusions. He was started on intravenous steroids, which significantly improved the bilateral opacities on repeat chest X-rays. He also underwent bilateral thoracentesis. Eventually, he was extubated and improved to room air. Covid-19, Influenza A and B, Sputum, blood, and pleural fluid cultures were negative. Discussion Strong recent vaping history with lung injury not explained by infection suggests EVALI as the cause of ARDS in this case. As per CDC guidelines, A confirmed EVALI case requires recent use (within 90 days) of vaping products, lung opacities seen on chest imaging, and exclusion of lung infections through negative tests for respiratory viruses and bacterial infections, as well as no alternative plausible diagnoses. For a probable EVALI case, infection may be identified or infection testing may be incomplete; however, the clinical team believes infection alone does not explain the lung injury. There must also be no plausible alternative diagnosis. This case emphasizes the critical importance of clinical awareness and early recognition of EVALI, particularly among young patients presenting with acute respiratory failure. Given such presentations, the CDC strongly recommends avoiding THC-containing vaping products and discourages e-cigarette use among youth, young adults, pregnant women, and non-tobacco users. This abstract is funded by: None
Girdhar et al. (Fri,) studied this question.