Severe Dyspnea in a Young Male

Abstract

INTRODUCTION: E-cigarette or vaping associated lung injury (EVALI) can cause severe respiratory illness. Although the pathophysiology is relatively unknown, flavored additives are thought to be associated with the damaging effects. We present a case of hypoxic respiratory failure due to EVALI. CASE PRESENTATION: An 18-year-old male presented to the emergency department (ED) with shortness of breath and pleuritic chest pain for two days. Chest radiograph suggested community acquired pneumonia and the patient was discharged with azithromycin. The following day, the patient returned with worsening dyspnea. His labs showed a white cell count of 15.8k/ mm3 and lactic acid of 2.5 mg/dL. Computed tomogram (CT) showed bilateral infiltrate without any pulmonary embolism. He was tachycardic (110-120/min), tachypneic (15-25 breaths/min), and required supplemental oxygen through nasal cannula at 3L/ min. The patient was intubated and placed on mechanical ventilation. Though he had denied use prior to intubation, e-cigarette use was later confirmed from his friends. Blood cultures were obtained and the patient was started on empiric antibiotics. All cultures remained negative. Trans-bronchial biopsy revealed fibrinous material admixed with a focal organizing pneumonia pattern and broncho-alveolar lavage (BAL) revealed lipid laden macrophages. He was started on high dose steroid. He was successfully extubated after 3 days.