B26-18 Acute Respiratory Distress Syndrome Secondary to Suspected E-cigarette or Vaping Product Use-associated Lung Injury (EVALI): A Case Report
Abstract
E-cigarette or vaping product use-associated lung injury (EVALI) is an acute or subacute respiratory illness characterized by severe lung injury from inhaling aerosols generated by vaping devices, which heat substances such as nicotine and cannabinoids. The exact cause remains unclear, but vitamin E acetate and tetrahydrocannabinol (THC) are implicated in most cases. Patients often present with respiratory and gastrointestinal symptoms, and diagnosis requires exclusion of infections and other lung diseases.
A 21-year-old male with no past medical or surgical history presented with shortness of breath for 1 day. He had been smoking heavily for the last 8-10 days, including 1-2 packs of cigarettes daily as well as heavy vaping. Initially, he required 2 L of oxygen via nasal cannula and subsequently required BiPAP support. A chest CT angiogram performed at the referring facility showed non-cardiogenic pulmonary edema consistent with possible ARDS. Given the initial suspicion of pneumonia, he was treated with intravenous antibiotics including vancomycin, cefepime, and azithromycin. Despite treatment, the patient’s acute hypoxic respiratory failure worsened, necessitating intubation and initiation of ARDS protocol. He had worsening bilateral mixed pulmonary opacities on repeat chest X-ray despite being on antibiotics. Chest CT revealed mixed interstitial and ground-glass opacities throughout both lungs with moderate bilateral pleural effusions. He was started on intravenous…
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