Coagulopathy and Inflammatory Dysregulation with E-Cigarette Use

Khanijo, Sameer; Lou, Becky; Makaryus, Mina; Weber, Andrew G.; Fryman, Craig; Iakovou, Annamaria

doi:10.1016/j.amjmed.2019.11.007

Cited by 10 publications

(7 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Inflammatory dysregulation, especially elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as seen in our patient can lead to coagulopathy explaining elevated INR in EVALI patients. Khanijo, S. suggested that procalcitonin can be falsely positive in these patients, limiting the utility of procalcitonin in suspected cases of EVALI [ 15 ]. The decision regarding outpatient management of suspected EVALI can be considered on a case to case basis, provided that the patient does not have hypoxemia at presentation (oxygen saturation<95%) and a close follow up (within 24–48 hours) can be arranged.…”

Section: Discussionmentioning

confidence: 99%

E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion

Mughal

Dalmacion

Mirza

et al. 2020

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Inhalation of aerosolized products generated by different electronic devices is called vaping. E-cigarettes or Vaping product use Associated Lung Injury (EVALI) outbreak peaked in August–September 2019 and gradually declined. EVALI remains a diagnosis of exclusion which presents as an acute lung injury in the vaping population. Vitamin E acetate and its products are implicated as one of the cytotoxic agents causing airway centered pneumonitis. Lipid laden macrophages are found in samples of BAL fluid but their role in cytopathology of the disease remains unclear. We present a 57 years old man who came to the emergency department at Monmouth Medical Center, New Jersey in fall, 2019. Reportedly he has been vaping THC about 100g every day for past three days. At initial presentation, he had fever, shortness of breath and hypoxia requiring supplemental oxygen. He was empirically treated with levofloxacin 500 mg for five days without a significant improvement in his symptoms. Non-contrast chest CT scan showed bilateral ground-glass opacities, indicative of diffuse alveolar damage. He underwent flexible bronchoscopy to rule out infective pneumonia followed by auto-immune work-up that was non-conclusive. He was given 1 mg/kg methylprednisolone with a quick taper of oral steroids leading to the resolution of symptoms. At six months follow-up, imaging showed near resolution of ground-glass opacities.

show abstract

Section: Discussionmentioning

confidence: 99%

E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion

Mughal

Dalmacion

Mirza

et al. 2020

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

show abstract

“…Coagulation abnormalities and inflammatory dysregulation have been described in both EVALI and COVID‐19. Khanijo et al 22 described elevated inflammatory markers such as CPR, ESR, and procalcitonin in their series of 24 patients with EVALI. Hematological, biochemical, inflammatory, and immune marker abnormalities have been described in COVID‐19 and they are used for risk stratification in the disease 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory findings in both COVID‐19 and EVALI can show elevated liver function tests, inflammatory markers such as ferritin, D‐dimer, CRP, and procalcitonin and abnormal coagulopathy 21–23 . Coagulation abnormalities and inflammatory dysregulation have been described in both EVALI and COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

E‐cigarette or vaping product use associated lung injury (EVALI) in the time of COVID‐19: A clinical dilemma

Helfgott

Capozzoli

Madray

et al. 2022

Pediatric Pulmonology

View full text Add to dashboard Cite

Aim To report on the clinical, laboratory, and radiological findings of adolescents who presented during the SARS‐CoV‐2 surge with symptoms of Coronavirus disease 2019 (COVID‐19), did not test positive for the infection, and were diagnosed with E‐cigarette and vaping product use associated lung injury (EVALI). Methods A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children's Hospital between February 2020 and June 2020 was conducted. Results The ages of the patients ranged from 14 to 19 years. There were six males and six females. Three patients had a past history of anxiety, depression, or other psychiatric/mental health disorder, 9 had prolonged coagulation profile (prothrombin time, partial thromboplastin time, and/or International Normalized Ratio), and 11 had elevated inflammatory markers. Eight needed respiratory support. All 12 were negative for SARS‐CoV‐2 PCR. Four were tested for IgG antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS‐CoV‐2 PCR was shown to be negative. Urine tetrahydrocannabinol was positive in all cases. Chest X‐ray and computed tomography findings showed ground glass opacities. Conclusions Clinical and radiological features are similar in both EVALI and SARS‐CoV‐2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with “typical” COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health‐care providers need to be aware of other conditions that can masquerade as SARS‐CoV‐2.

show abstract

“…Bloodwork doesn’t show specifical evidences, nevertheless, some elements may be evocative of EVALI: a non-specific raise of the inflammation indexes may be detected. Blood exams may also be useful to exclude other processes in the differential diagnosis [ 13 , 14 ]. The radiological evaluation in patients with suspected EVALI generally shows diffuse hazy or consolidative opacities at the chest radiograph.…”

Section: Discussionmentioning

confidence: 99%

E-cigarette or Vaping product use Associated Lung Injury (EVALI) in a 15 year old female patient – case report

et al. 2022

View full text Add to dashboard Cite

Background E-cigarettes are devices which allow to aerosolize liquids containing nicotine or other substances. Ever since they were released on the market in 2006, the number of users have been constantly increasing, especially among adolescents, ranging from 7,6% to 9,3% in the age group 18–24 years old from 2014 to 2019. Hand in hand with the spread of E-cigarettes many have been the efforts to understand their impact on health. EVALI (E-cigarette or Vaping product use Associated Lung Injury) is an emerging condition with a heterogeneous presentation with several reported cases worldwide. We mean to report a case of EVALI in a 15-year-old female Caucasian patient, who's currently attending her clinic follow-up at Bambino Gesù Pediatric Hospital in Rome. Case presentation The patient was admitted to the Emergency Room due to acute respiratory failure in November 2020. At admittance, she was severely dyspneic (HR 120 bpm, SatO2 75%). As she was hospitalized amid the COVID-19 pandemics, she underwent a nasopharyngeal swab for SARS-CoV2, which turned out negative, and a chest CT scan. Chest CT scan showed a central ground grass pattern with peripheral sparing. At the anamnestic recall, it was disclosed she was an e-cigarette smoker and occasional marijuana user. The microbiological work-up proved only positive for Rhinovirus. Her clinical and radiological case was discussed with our radiologist who suspected EVALI. She was assisted through HFNC, antibiotical therapy and corticosteroids with a dramatic recovery within the first 48 h. Conclusions EVALI started being recognized a specifically nosological entity in summer 2019, with increasing cases being reported. No diagnostic criteria have been agreed upon yet, but its usual presentation includes respiratory, gastrointestinal and systemic symptoms of different degree and the diagnosis can be hypothesised in case the patient has an evocative clinical and radiological presentation and has been an E-cigarette smoker in previous 90 days. Due to the novelty of the condition and its heterogeneous presentation it is of interest to report the cases in which EVALI is identified to raise awareness about this emerging new-age disease.

show abstract

Coagulopathy and Inflammatory Dysregulation with E-Cigarette Use

Cited by 10 publications

References 4 publications

E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion

E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion

E‐cigarette or vaping product use associated lung injury (EVALI) in the time of COVID‐19: A clinical dilemma

E-cigarette or Vaping product use Associated Lung Injury (EVALI) in a 15 year old female patient – case report

Contact Info

Product

Resources

About