EVALI-ASSOCIATED LIPID LADEN MACROPHAGES: CASE SERIES IN SOUTH TEXAS

Abstract

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To describe the clinical features, proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage (BAL), and outcomes of patients with Electronic cigarette/Vaping-Associated Lung Injury (EVALI). METHODS: Clinical characteristics, radiographs, and BAL samples were reviewed for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio, Texas from 9/2019 to 5/2020. RESULTS: We report 10 cases (9 men; median age, 32 years [range, 22-44]), with a history of vaping Tetrahydrocannabinol (THC). The most common signs/symptoms were tachycardia (N=10), dyspnea (N=9), cough (N=6), productive cough (N=3), and fever (N=6) occurring at least 1-28 days (median, 7 days) prior to presentation. All patients required supplemental oxygen, 5 required high-flow nasal cannula, and 3 required mechanical ventilation. Bilateral ground-glass opacities (GGO) with peripheral sparing on computerized tomography (CT) chest were noted in all patients. Sputum and blood cultures were all negative, except for one who had rhinovirus on the respiratory viral panel. Due to high clinical suspicion of EVALI, bronchoscopy was performed and cytology demonstrated lipid-laden macrophages on the oil-red-O stain on BAL in all patients (N=10) with a mean lipid-saturation percentage of 79% [range, 44-100%] and the mean Colombo count of 194 [range, 101-359]. All but one patient was treated with systemic corticosteroids (5 before bronchoscopy, 4 following bronchoscopy). Medium time to steroid administration was 3 days with an outpatient taper. The median length of stay was 10 days [range, 4-25 days]. No patients required supplemental oxygen at discharge. All 7 of those who had follow-up imaging at 6-12 weeks showed resolution of GGO and all 10 patients reported symptom resolution and no further vaping after discharge. CONCLUSIONS: We present a case series describing the diagnosis and successful management of patients with EVALI based on maintaining a high clinical suspicion, appropriate diagnostic testing including labs, imaging, and bronchoscopy with BAL stains for lipid-laden macrophages, as well as routine studies to rule out infectious etiologies, followed by early and aggressive treatment with systemic corticosteroids. CLINICAL IMPLICATIONS: Currently, no particular test has been identified to confirm EVALI. Diagnosis is based on a high clinical suspicion in patients with vaping exposure, as well as obtaining classic imaging and laboratory tests to rule out other potential etiologies. Bronchoscopy and BAL with lipid stains in the appropriate clinical setting may assist clinicians in early diagnosis and in decisions regarding initiating aggressive corticosteroid therapy in these patients. Counseling about vaping cessation is also critical for these patients. DISCLOSURES: Unrestricted grant for CME research relationship with AstraZeneca Please note: $20001 - $100000 Added 05/31/2020 by Sandra Adams, source=Web Response, value=Grant/Research Support Unrestricted grant for CME research relationship with Boehringer Ingelheim Please note: $20001 - $100000 Added 05/31/2020 by Sandra Adams, source=Web Response, value=Grant/Research Support Unrestricted grant for CME research relationship with GlaxoSmithKline Please note: $20001 - $100000 Added 05/31/2020 by Sandra Adams, source=Web Response, value=Grant/Research Support Unrestricted grant for CME research relationship with Sunovion Please note: $20001 - $100000 Added 05/31/2020 by Sandra Adams, source=Web Response, value=Grant/Research Support Support for continuing medical education relationship with Mylan/Theravance Please note: $1001 - $5000 Added 05/31/2020 by Sandra Adams, source=Web Response, value=nebulizer/meds for teaching No relevant relationships by Moeezullah Beg, source=Web Response No relevant relationships by Mahnoor Mir, source=Web Response No relevant relationships by Jay Peters, source=Web Response