This week’s morning report focused on a patient presenting with constitutional symptoms and cough in the context of vape-product use, found to have hypoxemic respiratory failure with CT findings of diffuse ground glass opacities. A thorough infectious and auto-immune work up was largely unremarkable, and the patient was diagnosed with EVALI

Key learning points:

• EVALI (e-cigarette and vaping associated lung injury) was first recognized by the CDC in August 2019. To date, over 2000 cases have been reported to the CDC nationwide
• The pathophysiology is not clearly defined, but is likely due to chemically-induced lung injury from toxic compounds present in vaping products
• Patients can present with constitutional, respiratory and GI symptoms
• There is no specific diagnostic testing, however the most critical step is obtaining history of e-cigarette/vaping product use.
• It is important to rule out infectious etiologies, and to consider concurrent infectious processes
• Cohort data suggests that imaging findings in EVALI are variable, as lung injury patterns can represent HSP, organizing pneumonia, DAH, acute eosinophilic or lipid pneumonia.
• The key step in management involves discontinuation of product use. Studies from hospitalized patients suggest corticosteroids may be helpful.

Check out the recently published CDC guide on management of EVALI.

Remember: new cases are reportable to the CDC through local health department (LA County Department of Public Health — Substance Abuse and Prevention Control).