Vaping-associated lung injury case report: A community hospital’s perspective

Abstract

Electronic Nicotine Delivery Systems (ENDS) aerosolize cannabis oils, nicotine, and other chemicals by heating alcohols and flavorants in order to produce a vapor for inhalation. With the rise in popularity of these devices, there is a rapidly growing number of life-threatening electronic-cigarettes, or vaping-associated lung injury (EVALI) cases throughout the country. Among the EVALI cases, similarities of presentation, symptoms, respiratory complications, and effective treatments have been reported, but the pathologic mechanisms of injury seem to vary by case. We report a series of two patients presenting with clinical symptoms and imaging findings consistent with vaping-associated lung injury in the setting of heavy nicotine and tetrahydrocannabinol (THC) vaping. The first case is a 19-year-old Caucasian male admitted to the hospital with dyspnea, nausea, emesis, weight loss, and early signs of acute respiratory distress syndrome. The second case is a 24-year-old Caucasian male who presented to the emergency room with a productive cough, fever, myalgias, and tachycardia. Both patients were initially treated as typical cases of community-acquired pneumonia without clinical improvement. After being discharged, the patient from case 2 was readmitted with new onset emesis and worsening dyspnea. Utilizing extensive laboratory testing, chest imaging, bronchoscopy, and lung biopsy, we established a diagnosis of EVALI in both cases. Both patients did well after appropriate treatment with intravenous steroids and empiric antibiotics. Despite the similarities among clinical presentations, discrepancies in the literature exist regarding the clinical outcomes and pathophysiology of EVALI. These case-by-case variations may result from differences in time to diagnosis, temporal factors in amount and timing of vape use, and the chemical composition of the products vaped. Our case reports highlight the increasing need for clinical awareness of EVALI, improved diagnostic tools for a timely diagnosis, and effective treatments of this potentially fatal respiratory illness.