D104-01 When Vaping Meets Vulnerability: Necrotizing Pneumonia and E-cigarette or Vaping-Associated Lung Injury (EVALI) in a Patient With Selective IgA Deficiency
Abstract
Selective IgA deficiency (sIgAD) is the most common primary immunodeficiency frequently associated with recurrent respiratory infections due to impaired mucosal immunity. E-cigarette or vaping-associated lung injury (EVALI) is an emerging cause of acute lung injury characterized by lipid-mediated alveolar inflammation and diffuse lung injury. We describe the synergistic effects of vaping-related injury and underlying immunodeficiency as contributors to severe pulmonary infection.
A 24-year-old man with childhood asthma and recurrent pneumonias presented with pleuritic chest pain, productive cough, and fever following a recent transition from cigarette smoking to heavy vaping (approximately 3,000 puffs per week). On presentation, he was febrile, tachypneic, and hypoxemic, requiring supplemental oxygen. Chest CT revealed left lower-lobe necrotizing consolidation with a loculated pleural effusion. Serum immunoglobulin testing demonstrated selective IgA deficiency. Empiric intravenous piperacillin-tazobactam and vancomycin were initiated. Interventional radiology placed a pleural drain, and pleural fluid analysis was consistent with empyema (glucose 3,000 U/L). Initial cultures were negative. Despite antibiotics and intrapleural fibrinolytic therapy (tPA and dornase alfa), his respiratory failure progressed, necessitating endotracheal intubation. On hospital day 11, he underwent video-assisted thoracoscopic surgery (VATS) with decortication. During single-lung ventilation, he…
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