Cytologic features of vaping‐induced lung injury: A case report

Ocampo‐Gonzalez, Fernando Alekos; Park, Ji-Weon

doi:10.1002/dc.24343

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…Tables 2 and 3. Most common diagnosis was EVALI (n = 15) [26][27][28][29][30][31][32][33][34][35][36] or EVALI with an additional finding (n = 1) [37]. Second most common diagnosis included either organizing pneumonia/ Bronchiolitis obliterans with organizing pneumonia (BOOP)/ respiratory bronchiolitis (n = 12) [38][39][40][41][42][43][44][45][46] or lipoid pneumonia (n = 9) [11,[47][48][49][50][51].…”

Section: Classification Of Casesmentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

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Section: Classification Of Casesmentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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“…In our case, the Oil Red O stain, which stains the lipid droplets in macrophages/ histiocytes, was strongly positive in the sections from the patient's lungs. This is supporting evidence of vaping, but it is not specific [9][10][11]. However, acute inhalational injury was documented by video bronchoscopy, and this provided confirmatory evidence of the vaping-induced lung injury [3-7, 12, 13].…”

Section: Discussionmentioning

confidence: 80%

Deadly combination of Vaping-lnduced lung injury and Influenza: case report

Akkanti¹,

Hussain²,

Patel³

et al. 2020

Diagn Pathol

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Background: E-cigarette and vaping use-associated acute lung injury (EVALI) has been recently recognized as a complication in individuals who use vaping devices. Another consideration is that EVALI may have an adverse influence on the outcome of intercurrent respiratory infections. We document this deadly combination in the case of a young man who had EVALI and simultaneous Influenza-A infection leading to severe Acute Respiratory Distress Syndrome (ARDS). Case presentation: A 27-year-old male with a history of tobacco and vaping use was admitted to hospital after two weeks of flu-like symptoms, diarrhea and vomiting. A chest x-ray was consistent with multifocal pneumonia, and microbiological tests were positive for Influenza-A and methicillin-sensitive Staphalacoccus aureus (MSSA). Bronchoscopy provided evidence of acute inhalational injury. After admission, he acutely decompensated with severe hypoxia and hypotension; he required intubation, sedation and vasopressors. He developed sepsis with acute kidney failure, liver failure, biventricular systolic dysfunction and severe rhabdomyolysis. He was placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) initially and later changed to Veno-Arterial (VA) ECMO. Nevertheless, the patient continued to deteriorate, and he expired two weeks after admission. Conclusion: This case documents that EVALI can act as a major factor leading a respiratory infection to progress into severe ARDS with a fatal outcome.

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“…In cases that did have ORO stain performed on BAL specimens, variable findings have been reported. Several single case reports have described cases of EVALI with abundant OPM in BAL 4,8,10,11 . A report by Ocampo‐Gonzalez et al specified a threshold OPM count of 80% 11 .…”

Section: Discussionmentioning

confidence: 99%

“…This makes BAL an invaluable specimen in prospective EVALI patients, in many of whom lipid‐accumulating lung injuries have been shown to occur. Several investigations have shown that many EVALI patients had ORO‐positive, lipid‐laden alveolar macrophages (OPM) in their BAL specimens 4‐12 . Based on these observations, ORO in BAL specimens has been proposed as a potentially useful diagnostic tool in cases of suspected EVALI.…”

Section: Introductionmentioning

confidence: 99%

Significance of Oil‐Red‐O positive macrophages in bronchoalveolar lavage in diagnosing E‐cigarettes or vaping product use‐associated lung injury: A case series

Niu

Rivera-Colón

Molberg

et al. 2021

Diagnostic Cytopathology

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BackgroundLipid‐laden macrophages detected by Oil‐Red‐O (ORO) stain in fresh bronchoalveolar lavage (BAL) specimens have been proposed as a potential diagnostic marker for E‐cigarettes or vaping product use‐associated lung injury (EVALI). However, studies are few, and the sensitivity and specificity of the test have not been thoroughly investigated.MethodsWe performed ORO stain on fresh BAL specimens from six confirmed EVALI and 36 non‐EVALI patients. After semi‐quantitative analysis, the sensitivity and specificity of ORO‐positive macrophages (OPM) for detection of EVALI were calculated.ResultsNo significant difference in cytomorphology or raw macrophage count was observed between EVALI and non‐EVALI groups (49% vs 55% of all nucleated cells). However, with ORO stain, all EVALI specimens (6/6) showed a high percentage (≥50% of all macrophages) of OPM (mean 87%), and large (≥25% of host macrophage nuclear size) lipid droplets (mean 42%), while the majority of non‐EVALI specimens showed a low percentage of OPM (32/36, mean 10%), and small lipid droplets (34/36, mean 6%). The differences between the two groups in both high OPM and large lipid droplet rates are statistically significant (P < .0001 for both comparisons). The combined sensitivity and specificity of high OPM and large lipid droplets for diagnosing EVALI were 100% and 94%, respectively.ConclusionIn BAL specimens obtained from patients with clinically suspected EVALI, a high percentage of OPM with large lipid droplets showed high sensitivity and specificity for the diagnosis of EVALI and may serve as a potentially useful tool in the evaluation of vaping‐related lung injury, improving diagnostic accuracy.

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Cytologic features of vaping‐induced lung injury: A case report

Cited by 10 publications

References 8 publications

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Deadly combination of Vaping-lnduced lung injury and Influenza: case report

Significance of Oil‐Red‐O positive macrophages in bronchoalveolar lavage in diagnosing E‐cigarettes or vaping product use‐associated lung injury: A case series

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