Do Not Huff, Puff, or Vape That Stuff: Interstitial Airspace Disease in a Teenager

Abstract

A 17-year-old previously healthy male was admitted to the hospital for intractable and persistent vomiting, fever, cough, abdominal pain, and intermittent diarrhea and dehydration. He presented with severe chest pain and O2 desaturations up to 80% on room air. An infectious (including a nasopharyngeal swab), GI, and cardiac workup was completed and was negative except for elevated inflammatory markers with a C-reactive protein (CRP) level of 261 mg/L, erythrocyte sedimentation rate (ESR) of 53 mm/hr, and a D-dimer level of 0.93 mcg/ml. Chest X-ray showed diffuse multifocal infiltrates. The patient was treated with ceftriaxone and azithromycin initially for a suspected pneumonia. He was also started on 4L of nasal cannula O2 supplementation. Due to persistent hypoxic respiratory failure, worsening respiratory distress clinically, with tachypnea and retractions, and lab findings of elevated D-dimer, a chest CT was performed to rule out a pulmonary embolism (PE). Computed tomography (CT) findings were negative for PE but notable for diffuse airspace opacities, primarily within the lower lobes, with a ground-glass appearance concerning for ARDS. Upon further investigation of the social history, the patient admitted to vaping nicotine products for the past 4 years and tetrahydrocannabinol (THC) products within the last several months. He was immediately started on prednisone 30 mg BID for a diagnosis of e-cigarette or vaping product use-associated lung injury (EVALI) and started showing clinical improvement. The patient was able to be weaned off of supplemental oxygen to room air, and clinical symptoms of respiratory distress began to improve over the next 24 hours.

Fundamentals of vaping-associated pulmonary injury leading to severe respiratory distress

“…Multiple cells from each lung section were captured on each spot (50 μm in diameter) of the gene expression slide, conferring the spots with hybrid transcriptome for spatial analysis. Cell type identification of hybrid gene expression spots was done by cross-referencing spatial transcriptome to the Mouse Cell Atlas (MCA) single-cell annotated database ( 1 ) ( Fig 6A ). Spot mapping identified cell types in each cluster by score, with some spots mapping to multiple cell types ( Fig S4 , part 1 and 2).…”

“…As an alternative, rationally designed inhalation exposure models to provide biological insights are desperately needed. Paramount among the many questions to be addressed are: (1) what constituents of vape aerosol present substantial hazards for triggering pathological processes, and ( 2) what are predisposing factors for severe VAPI manifestation in some individuals? Identifying characteristics of "at risk" users will be critical to avoid potentially life changing pulmonary damage, and biological assessments using patient samples could offer diagnostic value for clinically relevant injury status evaluation.…”

“…Relative merit of vaping for “harm reduction” intervention that transitions smokers away from combustible cigarettes remains under attack because of widespread adoption of vaping as a social activity and lifestyle choice by “never smokers,” particularly adolescents ( 1 , 2 , 3 ). The electronic vaping-associated lung injury (EVALI) outbreak of 2019 serves as a sobering demonstration of potential dangers resulting from uninformed experimentation with vape juice composition ( 4 , 5 , 6 ).…”

Cardiac p16 Expression Following Vape Exposure with Nicotine Shows Sex-Specific Induction in Males but not Females

“…The meteoric rise in vaping has been particularly alarming due to adoption by individuals (the "never smokers") with no prior history of cigarettes that include a youthful demographic attracted by targeted advertising and the lure of experimentation [37][38][39][40][41] . Conflicting messages from pro-vaping versus anti-vaping advocacy groups coupled with disdain or mistrust of scientific literature lead to indifference or skepticism regarding health-related concerns 42,43 .…”

Fundamentals of Vaping-Associated Pulmonary Injury Leading to Severe Respiratory Distress

“…Relative merit of vaping for "harm reduction" intervention that transitions smokers away from combustible cigarettes remains under attack due to widespread adoption of vaping as a social activity and lifestyle choice by 'never smokers', particularly adolescents. (1)(2)(3) The Electronic Vaping-Associated Lung Injury (EVALI) outbreak of 2019 serves as a sobering demonstration of potential dangers resulting from uninformed experimentation with vape juice composition (4)(5)(6). In comparison, commercially sold vape juices and prefilled disposable devices typically do not provoke acute lung injury and respiratory distress as pointed out by vaping advocacy groups.…”