P1045 - Devastating Lung Injury with Distinct Histopathology Secondary to E-Cigarette Use

ENDS (Electronic Nicotine Delivery Systems) have achieved remarkable popularity with children and adolescents in recent years. Additionally, and perhaps most disturbingly, a 2013 survey found there to be fewer social and behavioral risk factors associated with ENDS use in comparison to conventional cigarette use, suggesting that ENDs are attracting youth that likely would not otherwise have used tobacco products. ENDS use may be a much more insidious problem than we have realized, highlighting the importance of screening patients seen in both the hospital and outpatient settings. EVALI (E-cigarette or vaping-associated lung injury) has recently begun to be recognized as a unique syndrome, with clear clinical criteria for diagnosis not yet defined. Due to the novelty of this syndrome, further data and observation are needed before definitive diagnostic criteria and histopathological findings can be established as pathognomonic of this entity. Our patient met surveillance case criteria as defined by the CDC for the diagnosis of EVALI, with history of ENDS use in the ninety days prior to symptom onset, diffuse interstitial infiltrate throughout the lungs on chest CT, absence of infectious processes on initial workup, and no plausible alternative diagnosis. He required increasing support, with ultimate ECMO and bilateral pneumonectomy and transplant before decannulation and initiation of physical rehabilitation. We explore his prolonged hospital course, the distinct histopathology of his lung injury, and the potentially devastating effects of these seemingly innocuous devices.