E-cigarette or Vaping Product Use-Associated Lung Injury Complicated by Pulmonary Aspergillosis

Abstract

Since the initial reports regarding the nationwide outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in August 2019 by the Centers for Disease Control and Prevention, a clear link has been established between EVALI and tetrahydrocannabinol (THC)-containing product use. We report a case of invasive pulmonary aspergillosis (IPA) as a complication of EVALI in an immunocompetent adolescent that resulted in a fatal outcome. We encourage physicians that are considering the diagnosis of EVALI be cognizant of the increased use of THC and other potential contaminants in vaping cartridges. IPA can be a fatal disease and early aggressive treatment is necessary.

Cannabis Vaping Among Youth and Young Adults: a Scoping Review

“…The case series and case reports detailed symptoms at diagnosis including respiratory, gastrointestinal, and constitutional symptoms; and information on the treatment and outcomes of numerous patients with EVALI. Among the case reports ( n = 34) [ 70 – 102 , 139 ], 10 studies were adolescent patients (12 to 17 year olds), and 23 involved young adults (18 to 29 year olds); 31 of the 34 cases reported vaping THC or THC use was confirmed through urine analysis. Different diagnostic presentations of individuals with EVALI were provided in the articles, which aligned with the broad case definition established by the CDC, which includes (1) e-cigarette use or dabbing resin within 90 days of symptom onset, (2) pulmonary infiltrate present on radiographs, (3) no evidence of pulmonary infection with minimum workup of a viral respiratory panel and influenza testing, and (4) no evidence of alternative plausible diagnosis [ 4 ].…”

Social determinants of health as drivers of fungal disease

“… 140 , 141 , 142 In one study, persons who use cannabis were 3.5 times more likely to develop an IFI compared to non-cannabis users. 141 Electronic cigarette use or vaping has been associated with invasive pulmonary aspergillosis infection 143 and Candida albicans growth in the gingiva of the oral cavity. 144 …”