Helfgott Daniel, Capozzoli Gabrielle, Madray Jovanna, Baig Aisha, Uppaluri Lakshmi, Gaur Sunanda, Simon Mitchell, Amorosa Judith, Ramagopal Maya
Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Department of Pediatrics, Division of Pulmonology and Cystic Fibrosis Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Pediatr Pulmonol. 2022 Mar;57(3):623-630. doi: 10.1002/ppul.25804. Epub 2022 Jan 17.
To report on the clinical, laboratory, and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of Coronavirus disease 2019 (COVID-19), did not test positive for the infection, and were diagnosed with E-cigarette and vaping product use associated lung injury (EVALI).
A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children's Hospital between February 2020 and June 2020 was conducted.
The ages of the patients ranged from 14 to 19 years. There were six males and six females. Three patients had a past history of anxiety, depression, or other psychiatric/mental health disorder, 9 had prolonged coagulation profile (prothrombin time, partial thromboplastin time, and/or International Normalized Ratio), and 11 had elevated inflammatory markers. Eight needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine tetrahydrocannabinol was positive in all cases. Chest X-ray and computed tomography findings showed ground glass opacities.
Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with "typical" COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health-care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.
报告在严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）激增期间出现2019冠状病毒病（COVID-19）症状、感染检测未呈阳性且被诊断为电子烟和雾化产品使用相关肺损伤（EVALI）的青少年的临床、实验室和放射学检查结果。
对2020年2月至2020年6月间收治于百时美施贵宝儿童医院的12例EVALI病例进行回顾性研究。
患者年龄在14至19岁之间。男性6例，女性6例。3例患者有焦虑、抑郁或其他精神/心理健康障碍病史，9例凝血指标延长（凝血酶原时间、部分凝血活酶时间和/或国际标准化比值），11例炎症标志物升高。8例需要呼吸支持。所有12例SARS-CoV-2聚合酶链反应（PCR）检测均为阴性。4例检测了IgG抗体，结果为阴性。由于这些病例入院是为了排除COVID感染，初始治疗包括羟氯喹。仅在SARS-CoV-2 PCR显示为阴性后才开始使用类固醇。所有病例尿四氢大麻酚均呈阳性。胸部X线和计算机断层扫描结果显示磨玻璃影。
EVALI和SARS-CoV-2感染的临床和放射学特征相似。两种情况炎症标志物均升高。对于表现出“典型”COVID肺炎样疾病的患者，详细的社会和物质使用史很重要。应尽早排除EVALI以开始适当治疗。鉴于当前的大流行，儿科医生和其他医疗保健提供者需要了解其他可能伪装成SARS-CoV-2的疾病。
