EVALI-RELATED PULMONARY TOXICITY

Abstract

TYPE: Case Report TOPIC: Occupational and Environmental Lung Diseases INTRODUCTION: E-cigarette or vaping induced lung injury (EVALI) among those using tetrahydrocannabinol (THC) containing liquid products has been associated with additive Vitamin E Acetate (VEAc), the only common compound bronchoalveolar lavage (BAL) identified. We present a case of acute respiratory failure attributed to EVALI where treatment was based on VEAc role. CASE PRESENTATION: A 44 year old female complaining of dyspnea, cough, and hemoptysis presented with acute hypoxic respiratory failure requiring high flow nasal oxygen therapy in intensive care. She endorsed frequent vaping of THC containing liquid products. Further history revealed recent change in product supplier. CT chest demonstrated diffuse ground glass infiltrates (Figure 1). Labs showed increased white blood cells 12.6 THOU/mcL (3.6-10.5) and C- reactive protein 313 mg/L (<5). BAL deferred for unfavorable respiratory status. Initial treatment included methylprednisolone and bronchodilators. Hypoxia and dyspnea improved on prednisone taper enabling complete weaning of supplemental oxygen. DISCUSSION: As of 2020, 82% of EVALI cases have been attributed to THC containing liquid products. Suspected pathogenesis is linked to VEAc’s pulmonary effects including surfactant layer and viscosity alterations with lipid laden macrophages (LLM), however the driving element remains unclear. Despite routine bronchoscopy, nonspecific LLM findings challenge its diagnostic contribution in cases without suspcious alternative diagnoses. Characterizing radiographic patterns, including organizing pneumonia, ground glass opacities and subpleural sparing, may be advantageous. Continued investigation into EVALI pathogenesis and radiology can improve diagnosis and treatment. CONCLUSIONS: Understanding VEAc's influence on gas exchange can help focus treatment on alveolar recruitment through high flow oxygen therapy and anti-inflammatories. DISCLOSURE: Nothing to declare. KEYWORD: E- cigarette or vaping induced lung injury