Diffuse Alveolar Hemorrhage: An Uncommon Manifestation of Vaping-associated Lung Injury

Abstract

Vaping involves the use of a device to deliver aerosolized nicotine and tetrahydrocannabinol (THC) oils to the lungs. Vaping continues to increase in popularity; however, because it is a novel drug delivery system there is little evidence regarding its safety and long-term consequences. Here, we present a 22-year-old Caucasian male who was admitted with acute hypoxic respiratory failure and massive hemoptysis. Contrasted computed tomography of the chest demonstrated ground glass opacities throughout all lung fields and bilateral pulmonary emboli. Bronchoalveolar lavage revealed increased red blood cell counts in serial aliquots, consistent with the diagnosis of diffuse alveolar hemorrhage (DAH). An extensive workup did not reveal an etiology for the DAH. However, further history was obtained, and the patient divulged daily vaping of THC. E-cigarette, or vaping, product use associated lung injury (EVALI) consists of a myriad of different lung injury patterns. Our case illustrates an uncommon presentation of EVALI with DAH and multiple pulmonary emboli.

Electronic Vaping-Induced Methicillin-Sensitive Staphylococcus Aureus Pneumonia and Empyema

“…One example of this result is the e-cigarette or vaping use-associated lung injury (EVALI). EVALI imaging has revealed different radiographic presentations [ 10 ]. EVALI has reached epidemic proportions in the United States with close to 2,800 patients until February 2020 as per the Center for Disease Control and Prevention.…”

Vaping and diffuse alveolar hemorrhage: All EVALI is not created equal

“…In previous case reports, DAH has been shown to be associated with both use of nicotine only containing vape products [4][5][6] and use of tetrahydrocannabinol containing vape products. 7 Unfortunately, the none of the previous reports demonstrate a clear link between specific product use or dosing regimen and the development of DAH, and the heterogenous product use in our patient continues this trend. The nature of EVALI is heterogenous, including While hemorrhage in vaping has been attributed to inhalation products of heated liquid causing epithelial injury, 4 vaping aerosols lose significant heat 1 mm away from the coil.…”

The Utility of Bronchoscopy in Hydralazine-Induced ANCA-Associated Vasculitis

“…As evidenced by this reported case, there are indicators within the history and early diagnostic testing which can be used to raise clinical suspicion and even to potentially initiate therapy. Testing which can increase suspicion and may be rapidly obtained includes spun urine microscopy with direct visualization of red blood cell casts and bronchoscopy with serial aliquots indicative of diffuse alveolar hemorrhage [ 20 ]. In our case, spun urine microscopy did not reveal any red blood cell casts, but due to suggestive chest CT findings, even in the absence of significant pulmonary symptoms, we were able to perform a bronchoscopy within 24 hours of admission with findings consistent with diffuse alveolar hemorrhage.…”