Case Presentation: 23 year old male with history of 8 years of vaping presents with 3 days history of fever, tachypnea, diarrhea, nausea. On initial presentation he had signs of sepsis with hypoxia.Vitals: TMax – 102.7, PR – 119, BP 124/82, RR 28.Labs-WBC-14,800, N- 92%, L 1%, Hb 13.2, Platelets 276, Na 132, K – 3.7, Cl – 94, HCO3 25, Cr 1.45, GFR 60, BG 108, Lactate 1, Ca 8.8, LFTs – Wnl. ABG 7.47/33/68/24, 6 L, Pro cal 2.13, BNP 37, Influenza A and B neg. ESR 97, CRP 35, Utox – Cannabinoids, U Legionella, Pneumococcal Ag , Mycoplasma IgM were negative. Pro calcitonin 2.13, BNP-37, Influenza A and B- negESR 97, CRP-35, pro calcitonin 2.13, urine toxicology positive for cannabinoids. Chest X ray showed bilateral pneumonia and CT Scan showed bilateral infiltrates. He was treated with high dose steroids, empiric antibiotics and required high flow oxygen managed in ICU for 7days. His work up was negative for infective bacterial, viral pathology and discharged on tapering dose of steroids with follow up CT Scan in one week.
Discussion: E-VALI is a diagnosis of exclusion with no specific diagnostic test carrying significant morbidity and mortality.(Boland & Aesif, 2019) Patient is typically young male with 3 to 5 days of non-specific Viral prodrome of gastrointestinal, respiratory and musculoskeletal symptoms.(Balmes, 2019) They have a history of using electronic vaping with Cannabinoid/ flavors within one week of symptom onset.(Jatlaoui et al., 2019) Pt needs to be tested for bacterial PNA , influenza, viral respiratory panel and treated with supportive care with oxygen, bronchodilators and most of the hospitalized patients required steroids.(Blagev et al., 2019) CXR and CT scan show bilateral interstitial infiltrates. (Triantafyllou et al., 2019)(Blagev et al., 2019)(Jatlaoui et al., 2019)
Conclusions: E-cigarettes/ Vape Associated Lung Injury/(E-VALI)/VALI) is a modern epidemic according to CDC and is affecting all territories of US except Alaska. According to CDC as of Nov 21st 2290 cases were reports since march and there have been 47 deaths in 25 states with case fatality rate of 2.5%.(Health, 2019) 95% of the cases had to be hospitalized and seems to have acute onset of with rapid deterioration. Most were male and less than 35 yrs old with median age of 24,84% of the cases had cannabinoid positive.(Davidson et al., 2019)This Modern epidemic with no diagnostic test having an incidence across the country with rapid onset and high mortality rate effecting predominantly healthy young populations has become public health concern. Its actual pathogenesis is not understood so it is imperative that the medical fraternity needs to be aware for early diagnosis and treatment. CDC has warned about upcoming influenza and viral respiratory illness season and need for awareness among physicians during this illness and high mortality rate.(Xantus, 2019) As such VALI has high mortality rate among young population using vape having a significant economic burden by health care utilization and loss productive days by work force with no insight on long term consequences, hence forth there should be multipronged approach in identification, treatment, prevention with collaboration of policy makers, manufacturers, health care personnel to curb this epidemic.
