Coagulopathy and Acute Respiratory Distress Syndrome: Dual Complications of E-Cigarette-Associated Lung Injury

Abstract

E-cigarette-associated lung injury (EVALI) is related to the usage of e-cigarettes or a related product (e.g., “vaping” or “dabbing”). It presents mainly with constitutional, respiratory, or gastrointestinal symptoms, and EVALI is currently a diagnosis of exclusion. EVALI patients are more prone to rapid clinical decline requiring close monitoring, with some requiring intensive care unit (ICU) level of care or intubation. Mortality occurs in rare cases. We are presenting an interesting case of a male in his mid-60s who presented to the emergency department with worsening dyspnea and cough for two weeks, preceded by a one-week history of fever, nausea, and diarrhea. He was diagnosed with bilateral pneumonia based on computed tomography (CT) findings. Subsequent CT of the chest showed worsening bilateral diffuse ground-glass opacities (GGOs) correlating with acute respiratory distress syndrome (ARDS). Laboratory workup showed leukocytosis and lactic acidosis. The rest of the laboratory workup was normal. The patient was intubated due to ARDS, developed multiorgan failure, and passed away subsequently.

Vaping-Induced Sepsis and Rapidly Evolving Pleural Effusion in a Young, Otherwise Healthy Male

“…As of February 18, 2020, the Centers for Disease Control and Prevention (CDC) had reported that a total of 2,807 people had been hospitalized with lung injuries or deaths because of e-cigarettes or vaping. Based on these statistics, the CDC proposed the diagnostic criterion for a “confirmed case” of EVALI as follows: (1) use of an e-cigarette or a related product (e.g., “vaping” or “dabbing”) in the previous 90 days; (2) lung opacities on the chest imaging (radiograph or CT scan); (3) exclusion of lung infection; and (4) absence of a likely alternative diagnosis (e.g., cardiac, neoplastic, and rheumatologic) [ 5 ]. In patients, such as our patient, who did not have a complete pulmonary infectious work-up (i.e., respiratory viral panel, influenza testing, etc.)…”

Respiratory Impairment Related To Vaping

“…These avoring agents can directly impact free radicals generation. E-cigarette vapour contains 10 11 free radicals per puff in comparison to classical tobacco smoke containing 10 14 [38] [39]. It leads to oxidative stress and in ammatory response in the respiratory system.…”

“…Initially the respiratory (bacterial, viral or fungal) infection and other alternative diagnoses must be excluded (scheme 1) [6] [12] [13]. The viral panel includes in uenza A and B virus, parain uenza virus 1, 2 and 3, respiratory syncytial virus, adenovirus, rhinovirus, enterovirus [14]. SARS-CoV-2 infection must be also excluded.…”

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

“…Rapid evolution of the vaping industry coupled with unpredictable trending preferences of end users can have devastating consequences such as the EVALI outbreak, which was quickly correlated to ill-conceived modifications in “Dank Vape” juices ( 48 , 49 ). However, severe respiratory distress syndromes linked to VAPI are increasingly seen in the clinical setting involving vapers using commercially sourced devices and vape fluid ( 15 , 50 , 51 , 52 , 53 , 54 ). Evolution and onset of VAPI in otherwise healthy individuals remains poorly understood, especially on cellular and molecular levels.…”