E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) Mimicking COVID-19 Disease

Abstract

Background. Coronavirus 2 (SARS-CoV-2) is the virus associated with the coronavirus disease (COVID-19) causing a pandemic worldwide in 2020. There are other noninfectious diseases that can present exactly as COVID-19, and the management and approach are completely different, hence the importance of understanding and having a wide differential in patients presenting with similar characteristics. Case Report. A 23-year-old male, with a history of childhood asthma, presented to the Emergency Department in a hospital in south Florida in the USA with complaints of a 2-day duration of subjective fever, chills, dry cough, dyspnea, and myalgia. His vital signs were blood pressure 135/65 mmHg, temperature 39°C, pulse 134 bpm, respiratory rate 22 breaths per minute, and saturation of oxygen 96% in room air. Laboratory analysis was significant for white blood cells 15.3 × 10 3 /μL, ALT 69 U/L, AST 66 U/L, ferritin 375.6 ng/mL, C-reactive protein 27.70 mg/dL, and procalcitonin 1.43 ng/mL. A respiratory pathogen panel (RPP) and a SARS-CoV-2 test were both negative. The patient was given empiric antibiotic treatment and hydroxychloroquine. Two more tests for SARS-CoV-2 were negative, and the patient reported that he smoked marijuana through an e-cigarette. The patient was started on high-dose steroids, and symptoms improved. Conclusion. COVID-19 is an emergent lung disease that is affecting the population worldwide; many other noninfectious diseases can mimic its presentations and laboratory characteristics; the importance of having a broad differential diagnosis especially in causing confusion during pandemic times is valuable in the management of patients with such presentations, such as EVALI, and glucocorticoids will be indicated in this circumstances.

Cigarette and E-Cigarettes Dual Users, Exclusive Users and COVID-19: Findings from Four UK Birth Cohort Studies

“…Heightened odds of self-reported COVID-19 infection among dual tobacco users could be due to the fact that dual users were exposed to elevated levels of nicotine and toxicants via cigarette smoking and vaping, which adversely affects lung function [13,14], thus leading to a significant increase of susceptibility to COVID-19 infection compared to single product users. While we only found a significant association of self-reported COVID-19 infection for dual users, other studies have found an association between exclusive cigarette or e-cigarette use, respectively, with more severe COVID-19 progression [6,7,12].…”

“…Sufficient evidence shows using e-cigarettes, or vaping, is harmful to lung function [ 10 , 11 ]. Both cigarette and e-cigarette use damage the respiratory system [ 10 , 12 ], potentially increasing the risk of experiencing COVID-19-related measures, such as symptoms and diagnosis. This poses an alarming risk for dual users as they might suffer elevated health risks from the use of use multiple tobacco products and increase their susceptibility to infection and result in worse prognosis once infected [ 9 , 13 , 14 ].…”

Electronic Cigarettes and Asthma: What Do We Know So Far?

“…Even second-hand EC exposure was associated with higher odds of reporting an asthma attack in adolescents [ 104 ] and children [ 105 ]. Additionally, several cases of EVALI (some of them mimicking COVID-19) were recently reported in patients with a history of asthma [ 49 , 62 , 106 , 107 , 108 , 109 ]. Asthma is more common in patients with EVALI (approximately 30%; 43.6% in adolescents and 28.3% in adults) compared to the 8% to 10% of the general population [ 109 , 110 ].…”

“…EC devices can contain cannabis-based products including tetrahydrocannabinol (THC), the psychoactive component of cannabis (marijuana) [ 18 ]. Several asthmatics have suffered from EVALI after the use of such devices [ 49 , 107 , 108 ]. Two more cross-sectional studies have demonstrated the association between EC and cannabis [ 66 , 110 ], whereas another cross-sectional study has shown the opposite [ 78 ].…”

An Epidemic Supplanted by a Pandemic: Vaping-Related Illness and COVID-19

“… 47 Although vaping-related illness may have nearly disappeared as a consequence of increased public awareness resulting in risk reduction by users and by removal of vitamin E acetate from vaping products, a case report of a patient in April 2020 reminds clinicians that EVALI should remain in the differential diagnosis for young patients admitted with severe lung injury. 48 Presenting symptoms of EVALI (dyspnea, cough, fever, nausea, vomiting, and diarrhea) overlap with those of COVID-19, 36 , 49 , 50 and during population surges of the pandemic there is a tendency to narrow diagnostic considerations. As noted previously, EVALI is considered a diagnosis of exclusion, particularly exclusion of infectious etiologies, but critical to making the diagnosis is asking patients about vaping exposures.…”