Case Presentation: Here-in, we presented a 27-year-old female who initially presented to an outside hospital with complaints of extreme fatigue, fevers, and diffuse myalgia in the setting of cough, shortness of breath and sharp lower abdominal and back pain. Upon thorough questioning, she admitted to using vaporized Cannabidiol oil for the past 3-4 weeks to manage knee pain from jogging. Outside hospital ordered Chest XR and CT Abdomen which were notable for bilateral ground glass opacities at which point she was started on empiric antibiotics for pneumonia treatment. Upon transfer to our hospital and admission, patient complained of fatigue and cough with SpO2 of 97% as well as dull abdominal and pelvic pain. Patient had been febrile at outside hospital however vital signs were stable upon transfer and physical exam was negative except for the patient appearing listless. Admission lab studies were grossly unremarkable, except for a mild anemia likely attributed to patient’s age and gender. Repeat CT chest confirmed bilateral ground glass opacities, however, infectious work-up, including blood cultures, extended viral NAAT panel, atypical pneumonia NAAT, mycoplasma pneumonia IgM titrate and procalcitonin were all negative. Pulmonology was consulted and patient was diagnosed with VAPI as a diagnosis of exclusion. She was prescribed oral Prednisone 30mg for 10 days and fortunately her shortness of breath improved without need for ventilatory support. She was discharged on hospital day 3.
Discussion: Here we present a case of Vaping Associated Pulmonary Injury (VAPI) in order to improve awareness of this diagnosis in light of increased reports of severe illness and mortality. VAPI is an emerging public health epidemic with a non-discriminatory constellation of symptoms and varied presentation. Upon admission for lung injury, extensive history must be taken for recent use of e-cigarettes or marijuana substances, particularly with patients in their teens and early twenties in whom vaping is more common. Patients with VAPI can experience rapidly decompensating pulmonary status with the need for urgent ventilatory support. Thus, early recognition of this association in at-risk patients is essential to mitigate the predictable increased morbidity and mortality associated with VAPI. The exact mechanism underlying this condition remains unknown, although Food and Drug Administration officials have focused in on chemicals such as Vitamin E Acetate for the cause of this injury. Further research should seek to definitively identify the causative substance.
Conclusions: With recent reports of severe pulmonary disease in association with the use of vaporized nicotine or marijuana, the potential dangers of vaping have generated significant interest from both the field of medicine and the public eye. As the number of reported cases and deaths rise, increased provider awareness is vital to prevent further morbidity and mortality due to VAPI.