C48-06 Vaping Is Better Than Cigarettes, Isn’t It? Diffuse Alveolar Hemorrhage: A Case of EVALI

Diffuse alveolar hemorrhage (DAH) is a pulmonary crisis involving bleeding into the alveolar spaces of the lungs. The etiology of DAH is typically caused by autoimmune disease, cardiac disease, coagulation disorders, inhalational injury, infection, or malignancy. Electronic cigarette or vaping associated lung injury (EVALI) associated DAH will be discussed in this case report. EVALI is a spectrum of acute respiratory illnesses caused by additives in e-cigarettes and vapes, such as THC and Vitamin E acetate, oils, and nicotine. The diagnosis of EVALI is made when a patient presents with a recent history of vaping (especially THC oils), has bilateral ground glass opacities on a CT chest, and does not have a history of autoimmune disease or an immunocompromised state. Here we present the case of a 40-year-old male with no past medical history who was assessed to have EVALI after appropriate exclusions were made. The patient initially presented to the hospital after being found unresponsive by his wife. His wife reported that he had been on a weight loss program, had not eaten in a few days, and had been vaping THC excessively through a cartridge to keep his mind off his appetite. On arrival to the ED, the patient required endotracheal intubation due to a poor Glasgow coma score and significant hypercapnia. A CT chest with contrast revealed diffuse bilateral patchy multifocal areas of consolidation and ground glass opacities. The patient was admitted to the medical ICU and started on broad spectrum antibiotics. A bronchoscopy was performed on the first day of ICU admission, revealing thin bloody secretions in the left and right bronchial tree. A bronchoalveolar lavage of the RLL was then obtained in 3 serial aliquots which were all bloody with similar color throughout, consistent with DAH. Anca studies and GBM antibodies were negative and no laboratory signs of infection were found. A clinical assessment of EVALI was made and solumedrol 1 g for 3 days was initiated. After this the patient quickly improved. He was extubated after a 3-day ICU stay and transferred to the floor where he quickly recovered and was discharged home in stable condition. This case underscores EVALI as a key differential in patients with DAH when other causes have been excluded. Overall, it is important to consider EVALI when approaching patients with acute respiratory failure, bilateral ground glass opacities, and history of vaping.