Pulmonary Illness Related to E-Cigarette Use
Quite a lot of attention has been paid recently to the outbreak in idiopathic lung illness associated with vaping.
The New England Journal of Medicine has recently published an article exploring these cases and used the following criteria to define them:
- Reported use of e-cigarette devices and related products in the 90 days before symptom onset,
- Pulmonary infiltrates on imaging,
- Illnesses were not attributed to other causes.
Based on the above criteria, there were 53 case-patients, 83% of whom were male; the median age of the patients was 19 years.
Yes, 19!
The radiographs above come from the case of 17 yr old male with opacities in both lungs that were suggestive of infection or acute lung injury [Figure A].
The patient with no clinically significant medical history presented to a hospital ED with a 2-day history of shortness of breath, nonproductive cough, and generalized weakness as well as a 1-week history of fever before presentation, nausea, vomiting, abdominal pain, and diarrhea.
A radiograph of the chest that was obtained approximately 12 hours after presentation showed rapid worsening of diffuse lung opacities [Figure B].
High-resolution CT image of the chest showed diffuse hazy ground-glass opacities with subpleural sparing, findings consistent with pneumonitis [Figures C - E].
He began receiving high-dose intravenous glucocorticoids on day 2 of the hospitalization, and antibiotics were discontinued on day 4 because an infectious cause was deemed to be unlikely. The patient’s clinical condition improved, and he was extubated after receiving intravenous glucocorticoids for 3 days. The patient was discharged home on hospital day 6 with instructions to continue an oral glucocorticoid–tapering regimen for 6 weeks.
The full article and its data can be found via The New England Journal of Medicine
