Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping)

Abstract

Objectives The aim of this report is to describe the lung biopsy findings in vaping-associated pulmonary illness. Methods Lung biopsies from eight patients with vaping-associated pulmonary illness were reviewed. Results The biopsies were from eight men (aged 19-61 years) with respiratory symptoms following e-cigarette use (vaping). Workup for infection was negative in all cases, and there was no evidence for other etiologies. Imaging showed diffuse bilateral ground-glass opacities in all patients. Most recovered with corticosteroid therapy, while one died. Lung biopsies (seven transbronchial, one surgical) showed acute lung injury, including organizing pneumonia and/or diffuse alveolar damage. Common features were fibroblast plugs, hyaline membranes, fibrinous exudates, type 2 pneumocyte hyperplasia, and interstitial organization. Some cases featured a sparse interstitial chronic inflammatory infiltrate. Although macrophages were present within the airspaces in all cases, this feature was not prominent, and findings typical of exogenous lipoid pneumonia were absent. Conclusions The histopathology of acute pulmonary illness related to e-cigarette use (vaping) is characterized by acute lung injury patterns, supporting the contention that vaping can cause severe lung damage.

COVID-19 Autopsies, Oklahoma, USA

“…DAD has a long list of potential etiologies, including infection, vaping-associated pulmonary injury, oxygen toxicity, drug toxicity, toxic inhalants or ingestants, shock, severe trauma, sepsis, irradiation, and acute exacerbations of usual interstitial pneumonia. [4][5][6][7][8][9] Despite a burgeoning literature that provides insights into the clinical picture of COVID-19, very little is known about the pathologic manifestations. At the time of this writing (April 4, 2020), we are not aware of any published reports of complete autopsies on decedents with COVID-19 in the English literature.…”

E‐cigarette or vaping product use–associated lung injury: What is the role of cytologic assessment?

“…The clinical presentation of EVALI frequently is acute or subacute, with constitutional symptoms, cough, dyspnea, and/or gastrointestinal symptoms . Laboratory findings include an elevated white blood cell count and elevated erythrocyte sedimentation rate . Imaging most commonly demonstrates bilateral ground‐glass opacities or consolidation .…”

“…Laboratory findings include an elevated white blood cell count and elevated erythrocyte sedimentation rate . Imaging most commonly demonstrates bilateral ground‐glass opacities or consolidation . Because the findings are nonspecific, the entity remains a diagnosis of exclusion, and the CDC has provided interim criteria with which to identify such cases .…”

“…There is an apparent discordance between early reports that suggested exogenous lipoid pneumonia (ELP) on the basis of BAL cytology and subsequent lung biopsy series (including both transbronchial as well as surgical biopsies) without evidence of ELP . More specifically, BAL fluids with Oil Red O (ORO)‐staining, lipid‐laden macrophages “suggestive of ELP” have been described and received significant attention.…”

Vaping Perpetuates Cardiac Electrical Instability

“…In conclusion, our study is the first to show that vaping produces cardiac electrophysiological toxicity that include prolongation of the QT interval, reduced heart rate variability, inducibility of VT, and action potential alternans. The respiratory system is the major route of ENDS smoke entry into the body, and vaping related pulmonary illnesses are increasingly documented in the clinic 37 . However, similarly to combustible tobacco smoking, ENDS use could have potentially serious and harmful effects on the heart.…”