Pediatric Acute Respiratory Distress Syndrome and Hypersensitivity Pneumonitis Related to E-cigarette Vaping

Abstract

In recent years, electronic cigarettes (e-cigs) have been falsely advertised as safe alternatives to conventional smoking. We report a case involving a 16-year-old female who presented with fever, nonproductive cough, and shortness of breath after vaping e-cig/tetrahydrocannabinol dab pen. Her symptoms rapidly deteriorated and met diagnostic criteria for pediatric acute respiratory distress syndrome. Chest radiograph revealed extensive patchy airspace disease and computed tomography scan showed bilateral ground glass opacities. Bronchoalveolar lavage fluid revealed increased neutrophils, lymphocytosis, but absent eosinophilia. After the results of a comprehensive workup for infectious etiology returned negative, she was diagnosed with hypersensitivity pneumonitis and started on systemic corticosteroids.

Vaping-Associated Lung Injury: A Review

“…Since their introduction, there have been a number of case reports published describing a link between e-cigarette use and respiratory disease [ 5 , 6 , 7 , 8 , 9 , 28 ]. In the United States in 2019, there was a large number of lung injuries reported associated with e-cigarette use.…”

“…When inhaled these can alter the immune responses critical for normal lung function and cause lung injury. The pathological manifestation of this is diverse varying from organising pneumonia or diffuse alveolar damage to established interstitial lung disease (ILD) [ 5 , 6 , 7 , 8 , 9 ]. Originally marketed as a harm reduction tool for cigarette smokers [ 10 ], the number of people vaping continues to rise despite vaping related lung injury being increasingly recognised [ 11 ].…”

A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak

“…Electronic cigarette (e-cigarette), or nicotine vape, use among youth and young adults has been increasing in the United States ( Gentzke et al, 2019 , Bao et al, 2020 ), a cause for concern due to potential nicotine addiction, increased risk for use of other tobacco products and drugs, and long-term health risks ( Chadi et al, 2019 ). Evidence has also shown a wide array of short-term adverse experiences attributed to e-cigarette use ( Thota and Latham, 2014 , Khan et al, 2018 , Phung and Lam, 2020 , Hua and Talbot, 2016 , Cantrell, 2014 , Durmowicz et al, 2016 , King et al, June 2019 , King et al, 2019 , Hua et al, 2020 ). E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI), a uniquely severe adverse experience, garnered significant public attention in the summer of 2019 when a case series of patients presenting with pulmonary illness associated with e-cigarette use was reported ( Layden et al, 2020 ) and an increasing number of hospitalizations occurred across the United States ( Krishnasamy et al., 2020 ).…”