Vaping-Associated Lung Injury with Tetrahydrocannabinol Products: Short-Term Resolution in Computed Tomography Scan

Department

Internal Medicine

Document Type

Conference Proceeding

Publication Title

American Journal of Respiratory and Critical Care Medicine

Conference Name

ATS 2020 International Conference

Conference Date

2020-05-15

Abstract

Vaping-associated lung injury (VALI) is an emerging condition that mostly presents in vape or e-cigarette users. Recent case reports suggests a variety of initial symptoms. An 18-year-old male with a history of non-Hodgkin’s lymphoma in remission, migraines and anxiety presented with left sided pleuritic chest pain of one week duration. He also reported two days of subjective fever, chills, and shortness of breath. Social history was notable for daily vaping with THC, though he denied using it over the past week due to symptoms. Exam was notable for mild tachycardia, bilateral rhonchi. Chest X-ray (CXR) did not reveal an acute process, however chest tomography (CT) scan revealed bilateral ground glass pattern in the periphery, dominating the basal segments. He was initiated on steroids and antibiotics for community-acquired pneumonia (ceftriaxone, azithromycin). He was discharged after two days on oral levofloxacin and a course of steroids to complete a 7 day course. A follow-up CT in 8 weeks revealed resolution of the bilateral infiltrates. Inhalation pneumonitis is often associated with environmental exposures such as solvents, metals, household cleaning products, and explosions. Symptoms can range from mild respiratory irritation such as cough, pleuritic chest pain, to severe respiratory tract injury that can lead to respiratory failure. Clinical features include: use of vaping products within the past 90 days, absence of an infectious cause, and no other cardiopulmonary cause. CXR is recommended as initial imaging in those with high clinical suspicion. Layden et al. describes bilateral ground glass opacities, and relative subpleural sparing. Other patterns, such as pleural effusions, pneumomediastinum, and tree-in-bud opacities have been seen. The Center for Disease Control (CDC) has noted in the end of October 2019 that 1,604 cases have been reported associated with e-cigarettes/vaping-associated lung injury (EVALI/VALI). As of October 24, 2019, there have been 34 confirmed deaths in 24 states. No specific compound or agent for EVALI/VALI has been noted, however, there is growing data that majority of users have used tetrahydrocannabinol (THC) products. Bronchoscopy is not necessary for diagnosis, but it may be beneficial in excluding other etiology. Treatment options include empiric antibiotics, oxygen, steroids, and respiratory support. VALI is an emerging public health entity that may be initially overlooked for its subacute, nonspecific presentation. In certain patient populations, a detailed history of vaping, particularly THC products, may be warranted.

DOI

10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A1865

Volume

201

Publication Date

5-1-2020

Publisher

American Thoracic Society

Comments

Thematic Poster Session

A49. Vaping Case Reports

Abstract A1865

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