Diffuse Alveolar Hemorrhage Induced by Vaping

Abstract

There has been a significant increase in electronic cigarette (e-cigarette) use since its introduction in 2007. Ironically, there remains very few published literature on the respiratory complications of e-cigarettes. The use of personalized vaporizers or commonly known as “vaping” has started to overtake standard e-cigarette. Its dynamic vaporizer customization makes it challenging to assess long-term health effects. Case reports on the pulmonary complications of e-cigarettes are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis. Diffuse alveolar hemorrhage (DAH) is bleeding into the alveolar spaces of the lung secondary to disruption of the alveolar-capillary basement membrane. We report a case of young male presenting with subacute respiratory failure. He was later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping. This adds up to the rising concern on the possible serious complications of this innovative technology designed as a safer alternative to traditional cigarettes.

Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth

“…The current literature suggests that the most common imaging pattern is basilar-predominant consolidation and ground-glass opacity, often with areas of lobular or subpleural sparing, 51 although previous case reports have described diverse imaging findings. 5,[9][10][11]19,20,34,39,42,51 Similarly, the pathologic findings can vary, 13,26 although in the recent case series by Butt and colleagues, 26 all cases showed 1 or more pattern or feature of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, organizing pneumonia, interstitial edema, intra-alveolar fibrin and reactive type 2 pneumocyte hyperplasia. Additionally, airwaycentred accumulation of foamy macrophages in peribronchiolar airspaces was universally present, along with vacuolization of the cytoplasm of hyperplastic type 2 pneumocytes.…”

“…Published case reports of vaping-associated pulmonary disease date back to 2012, with an increase in reported cases over the last 3 years ( Figure 6). From 2012 to Aug. 30, 2019 (before publication of the CDC investigation), there were 30 publications [5][6][7][8][9][10][11][12][15][16][17][18][19][20]27,[29][30][31]34,[36][37][38][39][40][41][42][43][44][45][46] identifying a diverse array of vapingassociated pulmonary insults, with varying imaging and pathological findings, but no reported deaths (Table 1). From Sept. 1 to Oct. 30, 2019, an additional 13 publications 13,21,22,26,28,32,33,35,47,[51][52][53][54] were identified through our search strategy (Table 1).…”

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

“…Lastly, propylene glycol and glycerol produced by vaping have been associated with increased distal airway injury [12]. Limited case reports have implicated heavy metals, propylene glycol, and glycerol in the propagation of DAH [13][14][15]. Furthermore, our patient presents with a pulmonary embolism.…”

E-Zigaretten – Funktionsweise, Inhaltsstoffe und die Vaping-assoziierte akute Lungenschädigung

“…Ein spezifischer histologischer Befund der EVALI wurde bisher nicht identifiziert, jedoch sind die zwei häufigsten publizierten Schädigungsmuster die einer chemisch-toxischen Pneumonitis [38] und einer Lipoidpneumonie [23,44,48]. Weiterhin wurden Einzelfälle einer organisierenden Pneumonie [49,50], diffusen alveolären Hämorrhagie [51], akuten eosinophilen Pneumonie [52], Spontanpneumothorax [53], exogen allergischen Alveolitis [54] und Status asthmaticus [29] berichtet; auf diese wird in dieser Übersichtsarbeit jedoch aufgrund ihrer solitären Inzidenz nicht weiter eingegangen.…”