Vaping associated lung injury: A potentially life-threatening epidemic in US youth.
BACKGROUND
The Center for Disease Control (CDC) has identified a national outbreak in the United States of over 2600 cases of e-cigarette or vaping product use-associated lung injury (EVALI), including 60 deaths as of January 2020. We describe our experience in six adolescents.


MATERIAL AND METHODS
We identified all pediatric patients diagnosed with EVALI by CDC guidelines over a 6-month period at our health system. Clinical presentation, hospital course, and imaging were reviewed.


RESULTS
Six patients were identified (three males, three females; median age 18.5 years). Presenting symptoms varied, including constitutional, gastrointestinal, neurologic, and respiratory complaints with pulmonary symptomatology becoming the dominant feature of the illness. Three patients required intensive care unit-level care, one of whom expired 36 days after presentation. Three had bronchoalveolar lavage, two with evidence of lipid-laden macrophages. Four had pulmonary function testing with various results. Admission chest radiographs in all revealed bibasilar interstitial infiltrate which rapidly progressed. Five patients had computed tomography chest imaging demonstrating: confluent pulmonary infiltrates with subpleural sparing (n = 2), generalized ground-glass opacities (n = 1), patchy ground-glass opacities (n = 1) and a reticulonodular pattern (n = 1). Brain magnetic resonance imaging (MRI) obtained in two patients was normal in one and showed a focal signal abnormality in the corpus callosum in one.


CONCLUSION
We describe the clinical course and radiologic findings of EVALI in our adolescent patients and present a new finding in the brain not yet described in the literature. Given the diversity of presenting symptoms, a high level of suspicion for EVALI is necessary for patients reporting vaping product use regardless of the presence of pulmonary complaints. Brain MRI should be strongly considered in patients with neurologic symptoms.
['Messina|Mark D|MD|', 'Levin|Terry L|TL|', 'Conrad|Laura A|LA|', 'Bidiwala|Aneela|A|0000-0002-4881-368X']
D000293:Adolescent D000328:Adult D001921:Brain D066300:Electronic Nicotine Delivery Systems D058872:Epidemics D017809:Fatal Outcome D005260:Female D006801:Humans D055370:Lung Injury D008279:Magnetic Resonance Imaging D008297:Male D014057:Tomography, X-Ray Computed D014481:United States D000072137:Vaping D055815:Young Adult
vaping e-cigarette e-cigarette or vaping associated lung injury vaping-induced lung injury