Aberegg Scott K, Cirulis Meghan M, Maddock Sean D, Freeman Andrew, Keenan Lynn M, Pirozzi Cheryl S, Raman Sanjeev M, Schroeder Joyce, Mann Howard, Callahan Sean J
Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City.
Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City.
JAMA Netw Open. 2020 Nov 2;3(11):e2019176. doi: 10.1001/jamanetworkopen.2020.19176.
e-Cigarette, or vaping, product use-associated lung injury (EVALI) has caused more than 2800 illnesses and 68 deaths in the United States. Better characterization of this novel illness is needed to inform diagnosis and management.
To describe the clinical features, bronchoscopic findings, imaging patterns, and outcomes of EVALI.
DESIGN, SETTING, AND PARTICIPANTS: This case series of 31 adult patients diagnosed with EVALI between June 24 and December 10, 2019, took place at an academic medical center in Salt Lake City, Utah.
e-Cigarette use, also known as vaping.
Symptoms, laboratory findings, bronchoscopic results, imaging patterns, and clinical outcomes.
Data from 31 patients (median [interquartile range] age, 24 [21-31] years) were included in the study. Patients were primarily men (24 [77%]) and White individuals (27 [87%]) who used e-cigarette products containing tetrahydrocannabinol (THC) (29 [94%]). Patients presented with respiratory (30 [97%]), constitutional (28 [90%]), and gastrointestinal (28 [90%]) symptoms. Serum inflammatory markers were elevated in all patients. Bronchoscopy was performed in 23 of 28 inpatients (82%) and bronchoalveolar lavage (BAL) revealed the presence of lipid-laden macrophages (LLMs) in 22 of 24 cases (91%). BAL samples tested positive for Pneumocystis jirovecii (3 patients [13%]), rhinovirus (2 patients [8%]), human metapneumovirus and Aspergillus (1 patient each [4%]); all except human metapneumovirus were determined to be false-positives or clinically inconsequential. The exclusive or dominant computed tomography (CT) pattern was organizing pneumonia in 23 of 26 cases (89%). Patients received antibiotics (26 [84%]) and corticosteroids (24 [77%]), and all survived; 20 patients (65%) seen in follow-up showed marked improvement, but residual symptoms (13 [65%]), radiographic opacities (8 [40%]), and abnormal pulmonary function tests (8 of 18 [44%]) were common.
In this case series, patients with EVALI characteristically presented with a flu-like illness with elevated inflammatory markers, LLMs on BAL samples, and an organizing pneumonia pattern on CT imaging. Bronchoscopic testing for infection had a high incidence of false-positive results. Patients had substantial residual abnormal results at early follow-up. These data suggest a limited role for bronchoscopy in typical presentations of EVALI without risk factors for alternative diagnoses and the need for careful longitudinal follow-up.
电子烟或雾化产品使用相关肺损伤（EVALI）在美国已导致2800多人患病和68人死亡。需要更好地描述这种新型疾病，以指导诊断和管理。
描述EVALI的临床特征、支气管镜检查结果、影像学表现和转归。
设计、地点和参与者：本病例系列研究纳入了2019年6月24日至12月10日期间在犹他州盐湖城一家学术医疗中心诊断为EVALI的31例成年患者。
使用电子烟，也称为雾化。
症状、实验室检查结果、支气管镜检查结果、影像学表现和临床转归。
研究纳入了31例患者（年龄中位数[四分位间距]为24[21 - 31]岁）。患者主要为男性（24例[77%]）和白人个体（27例[87%]），使用含四氢大麻酚（THC）的电子烟产品（29例[94%]）。患者出现呼吸系统症状（30例[97%]）、全身症状（28例[90%]）和胃肠道症状（28例[90%]）。所有患者血清炎症标志物均升高。28例住院患者中有23例（82%）接受了支气管镜检查，24例中的22例（91%）支气管肺泡灌洗（BAL）显示存在充满脂质的巨噬细胞（LLMs）。BAL样本检测到耶氏肺孢子菌阳性（3例患者[13%]）、鼻病毒阳性（2例患者[8%]）、人偏肺病毒和曲霉菌阳性（各1例患者[4%]）；除人偏肺病毒外，其余均被判定为假阳性或临床意义不大。26例中的23例（89%）计算机断层扫描（CT）的唯一或主要表现为机化性肺炎。患者接受了抗生素治疗（26例[84%]）和糖皮质激素治疗（24例[77%]），所有患者均存活；随访的20例患者（65%）显示有明显改善，但残留症状（13例[65%]）、影像学opacity（8例[40%]）和异常肺功能检查结果（18例中的8例[44%]）很常见。
在本病例系列中，EVALI患者的特征性表现为类似流感的疾病，炎症标志物升高，BAL样本中有LLMs，CT影像学表现为机化性肺炎。支气管镜感染检测假阳性结果发生率高。患者在早期随访时有大量残留异常结果。这些数据表明，在无替代诊断危险因素的EVALI典型表现中，支气管镜检查作用有限，且需要仔细的长期随访。
