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

Abstract

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.

Vaping-associated illness: a reassessment

“…EVALI was also found to associated with hemophagocytic lymphohistiocytosis [27]. While symptoms of EVALI overlap with symptoms of COVID-19 [28,29], the pathogenesis of multiple system involvement may be very different for the two diseases. COVID-19 is mediated by the spike protein of the virus binding to ACE2 receptors which are expressed in multiple tissues including lung and intestine [26].…”

E-cigarettes and youth: an unresolved Public Health concern

“…Despite the absence of pathognomonic features, EVALI should be considered in younger patients, displaying leucocytosis and responsive to corticosteroids (being COVID-19 more likely in older ages and often associated with lymphopenia) [ 159 ]. Accordingly, vaping history should always be investigated – and excluded – in young patients presenting to emergency departments for acute fever and respiratory symptoms, especially in individuals with no epidemiologic links to SARS-CoV2 infection [ 158 , 161 ].…”