A CASE OF E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY IN AN INFREQUENT VAPE USER

Abstract

SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: We present a case that shows e-cigarette or vaping product use associated lung injury (EVALI) can occur even with infrequent use. CASE PRESENTATION: A 50-year-old woman presented with a 1-week history of malaise, shortness of breath, and dry cough. She admitted to consuming a THC containing vaping product 2-3 times a month for the past 1 year. Chest X-ray showed diffuse bilateral pulmonary infiltrates. CT Chest showed extensive centrilobular nodular opacities with small patchy consolidations in bilateral upper and lower lobes. Influenzae and HIV were negative. Serology testing for vasculitic and connective tissue disorders was negative. Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy of the right upper lobe was performed. Gram stain with culture, fungus culture, AFB culture, and Legionella were all negative. Histopathology showed evidence of focal organizing pneumonia and numerous foamy macrophages, which are findings described in EVALI. GMS and AFB stain were negative for infectious microorganisms. No malignant cells were seen on cytology. Given the constellation of findings, we concluded this was EVALI. She was started on prednisone and advised to refrain from vaping. On 6-week follow up in our outpatient pulmonary clinic, she endorsed complete resolution of symptoms. A repeat CT of the chest showed dramatic improvement with near complete resolution of the prior opacities. DISCUSSION: EVALI is a diagnosis of exclusion. The characteristic bilateral pulmonary infiltrates and the histopathology of foamy macrophages that are described in EVALI can be seen in other forms of lung diseases. Thus, confirming vaping history is vital to the diagnosis. In a case series of patients diagnosed with EVALI, the vast majority of patients admitted to at least daily use. This case reminds us that infrequent use of vaping can lead to EVALI as well. CONCLUSIONS: Given the popularity of e-cigarette and vaping use, clinicians should be aware that infrequent vaping use can lead to EVALI. We encourage a push for medical professionals to incorporate e-cigarette or vaping use as part of regular social history intake, regardless of clinical presentation. Due to the various factors that may prevent a patient from being open with their use, it is the role of the clinician to broach this topic in a nonjudgmental and confidential manner. Reference #1: Layden JE, Ghinai I, Pray I, et al. Pulmonary illness related to e-cigarette use in Illinois and Wisconsin - preliminary report. N Engl J Med 2019; https://doi-org.proxy.lib.fsu.edu/10.1056/NEJMoa1911614. Reference #2: Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019 MMWR Morb Mortal Wkly Rep. 2019 Oct 18; 68:919–927 DISCLOSURES: No relevant relationships by Kristina Akopyan, source=Web Response Speaker/Speaker's Bureau relationship with GlaxoSmithKline Please note: $1001 - $5000 Added 04/20/2020 by Alberto Fernandez, source=Web Response, value=Consulting fee No relevant relationships by Abdul Siddiqui, source=Web Response