P0642 - E-cigarette or Vaping Use Associated Lung Injury (EVALI) - New COPD of The Young?

Case Report: A 20 year old male was referred to the Emergency Center by his primary care physician for hypoxia. He reported shortness of breath, fever, fatigue, decreased appetite, dry cough, and generalized myalgias for the last four days. He recently returned to Michigan from a trip to Arizona, but denied engaging in any outdoor activities during his vacation. He endorsed a multiple year history of vaping THC "all day, every day" until about 10 days prior. In addition, the patient reported having unprotected sexual contacts while in Arizona, including sex with men.
Upon presentation to the Emergency Center, he was afebrile but tachycardic, tachypneic, with hypoxia of 90% on room air. Chest x-ray showed bilateral lower lobe interstitial infiltrate and leukocytosis of 19.6 billion/L with a left shift. Lactate and CRP were elevated at 2.5 mmol/L and 283.2 mg/L respectively. Patient was admitted for acute respiratory failure and pneumonia. Patient was initially started on azithromycin, ceftriaxone and Bactrim due to concern for pneumocystis. However, the patient clinically worsened overnight. On day 3 of admission, the patient required 6L of supplemental oxygen via nasal cannula with increased shortness of breath. A repeat chest X-ray showed worsening bilateral infiltrates. Infectious work-up including atypical bacteria, HIV and auto-immune work-up including rheumatoid, anti-nuclear were negative. By day 4, the patient required FiO2 65% oxygen. Pulmonology was consulted and the patient was started on IV solumedrol. After starting steroids, the patient made great improvement and was discharged on oral prednisone taper.

Discussion: In 2017, vaping was the most commonly used tobacco-like product among adolescents and it was estimated that about 1.3 million new adolescents were using e-cigarettes in 2018. In December 2018, it was declared by the U.S. Surgeon General that the e-cigarette was an epidemic among youth. It’s been reported that youth and young adults are under increasing exposure to e-cigarette through social media. One study reported that greater than 70% of youth and young adults in their sample reported exposure to e-cigarette marketing in just a month and that it serves as a driving force in young adults experimentally trying the e-cigarette. In addition to national efforts, it’s important for primary care physicians to bridge the gap of this vulnerable population who are making transition from adolescence to young adulthood as they make decisions based on information and influence from social media.