Doukas Sotirios G, Kavali Leena, Menon Rohan S, Izotov Boris N, Bukhari Amar
Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA.
Department of Forensic Sciences and Laboratory of Toxicology, Medical School, University of Crete, Heraklion, 71003, Greece.
Toxicol Rep. 2020 Oct 3;7:1381-1386. doi: 10.1016/j.toxrep.2020.09.010. eCollection 2020.
Recently, a rapidly increasing number of e-cigarette or vaping induced lung injury (EVALI) has been reported across the nation. Given the ongoing epidemic, it has been suggested that specific chemical substances used as additives in e-cigarettes could be highly related to EVALI. A history of vaping with positive radiographic changes and low suspicion for active infection are requirements for diagnosis but it still remains a diagnosis of exclusion. The course of the disease, mechanism of lung injury and the optimal management options need to be better understood. Here we aimed to discuss the clinical characteristics recognized in a case series of ten hospitalized EVALI patients with radiological findings of lung injury and provide an up today summary of the known literature of EVALI-induced lung injury.
A retrospective chart review was conducted on ten patients who presented to Saint Peter's University Hospital in New Brunswick, NJ from July 2019 to February 2020, with a mean hospital stay of five days. According to the CDC recommended definition of the disease, our cases met the current working definition of confirmed or probable cases of EVALI.
Ten patients, with mean age 30.8 years (50 % male) and average years of vaping 1.708 with 60 % endorsing a simultaneous history of cannabis-related products use, went under a retrospective review. 3/10 (30 %) had documented medically-managed pulmonary disease history, 8/10 (80 %) presented with the respiratory-related chief complaint, 6/10 (60 %) presented with gastrointestinal symptoms and 7/10 (70 %) had constitutional symptoms. All patients (100 %) were found to have bilateral ground-glass opacities on chest imaging. 9/10 were admitted, 6/10 (60 %) had an oxygen saturation of <95 % requiring oxygen supplementation with 4/10 managed in the intensive care unit.
EVALI patients with radiological findings of lung injury, although mainly present respiratory symptoms, may very often appear with constitutional and gastrointestinal symptoms. Based on the existing literature and our data it is argued that EVALI may be misdiagnosed and that closer monitoring is required to determine optimal diagnostic and therapeutic management of this condition. Our data and the existing literature suggest that laboratory and epidemiologic findings can be contributory for the diagnosis of the disease.
最近，全国各地报告的电子烟或雾化产品所致肺损伤（EVALI）病例数迅速增加。鉴于这一流行病仍在持续，有人认为电子烟中用作添加剂的特定化学物质可能与EVALI高度相关。有雾化史且影像学检查有阳性改变，同时对活动性感染怀疑度低，是诊断的必要条件，但EVALI仍然是一种排除性诊断。该病的病程、肺损伤机制以及最佳治疗方案仍需深入了解。在此，我们旨在讨论一组10例住院的有肺部损伤影像学表现的EVALI患者的临床特征，并对EVALI所致肺损伤的已知文献进行最新总结。
对2019年7月至2020年2月在新泽西州新不伦瑞克市圣彼得大学医院就诊的10例患者进行回顾性病历审查，平均住院时间为5天。根据美国疾病控制与预防中心（CDC）推荐的疾病定义，我们的病例符合EVALI确诊或疑似病例的现行工作定义。
对10例患者进行了回顾性审查，平均年龄30.8岁（50%为男性），平均雾化年限1.708年，60%的患者同时有使用大麻相关产品的病史。10例中有3例（30%）有药物治疗的肺部疾病记录，10例中有8例（80%）以呼吸系统相关主诉就诊，10例中有6例（60%）有胃肠道症状，10例中有7例（70%）有全身症状。所有患者（100%）胸部影像学检查均发现双侧磨玻璃影。10例中有9例入院，10例中有6例（60%）血氧饱和度<95%需要吸氧，其中10例中有4例在重症监护病房接受治疗。
有肺部损伤影像学表现的EVALI患者，虽然主要表现为呼吸道症状，但也常伴有全身和胃肠道症状。基于现有文献和我们的数据，有人认为EVALI可能会被误诊，需要密切监测以确定该病的最佳诊断和治疗方案。我们的数据和现有文献表明，实验室和流行病学检查结果有助于该病的诊断。
