Mughal Mohsin Sheraz, Dalmacion Denise Lauren V, Mirza Hasan Mahmood, Kaur Ikwinder Preet, Dela Cruz Maria Amanda, Kramer Violet E
Monmouth Medical Center, An Affiliate of RWJ/Barnabas Health System, 300 2nd Avenue Long Branch, New Jersey, 07740, USA.
Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Respir Med Case Rep. 2020 Jul 25;31:101174. doi: 10.1016/j.rmcr.2020.101174. eCollection 2020.
Inhalation of aerosolized products generated by different electronic devices is called vaping. E-cigarettes or Vaping product use Associated Lung Injury (EVALI) outbreak peaked in August-September 2019 and gradually declined. EVALI remains a diagnosis of exclusion which presents as an acute lung injury in the vaping population. Vitamin E acetate and its products are implicated as one of the cytotoxic agents causing airway centered pneumonitis. Lipid laden macrophages are found in samples of BAL fluid but their role in cytopathology of the disease remains unclear. We present a 57 years old man who came to the emergency department at Monmouth Medical Center, New Jersey in fall, 2019. Reportedly he has been vaping THC about 100g every day for past three days. At initial presentation, he had fever, shortness of breath and hypoxia requiring supplemental oxygen. He was empirically treated with levofloxacin 500 mg for five days without a significant improvement in his symptoms. Non-contrast chest CT scan showed bilateral ground-glass opacities, indicative of diffuse alveolar damage. He underwent flexible bronchoscopy to rule out infective pneumonia followed by auto-immune work-up that was non-conclusive. He was given 1 mg/kg methylprednisolone with a quick taper of oral steroids leading to the resolution of symptoms. At six months follow-up, imaging showed near resolution of ground-glass opacities.
吸入由不同电子设备产生的雾化产品被称为吸电子烟。电子烟或吸电子烟产品所致肺损伤（EVALI）疫情在2019年8月至9月达到高峰，随后逐渐下降。EVALI仍然是一种排除性诊断，在吸电子烟人群中表现为急性肺损伤。维生素E醋酸酯及其产品被认为是导致以气道为中心的肺炎的细胞毒性药物之一。在支气管肺泡灌洗（BAL）液样本中发现了充满脂质的巨噬细胞，但它们在该疾病细胞病理学中的作用仍不清楚。我们报告一名57岁男性，于2019年秋季前往新泽西州蒙茅斯医疗中心急诊科。据报道，在过去三天里，他每天吸食约100克四氢大麻酚（THC）。初诊时，他有发热、呼吸急促和缺氧，需要补充氧气。经验性给予左氧氟沙星500毫克治疗五天，但其症状无明显改善。非增强胸部CT扫描显示双侧磨玻璃影，提示弥漫性肺泡损伤。他接受了可弯曲支气管镜检查以排除感染性肺炎，随后进行的自身免疫检查未得出结论。给予他1毫克/千克甲泼尼龙，并迅速减量口服类固醇，症状得以缓解。在六个月的随访中，影像学显示磨玻璃影几乎消失。
