1/5
#IDgrandrounds
Teenager, h/o vaping, admitted w/ prolonged fever, cough, SOB, respiratory failure. CXR/CT: diffuse infiltrates. No response to antibiotics. Multiple ID/Rheum w/u (-). BAL +lipid-laden macrophages.
Dx: attributed to vaping-induced lung injury
2/5
E-cigs (vaping) contain less toxic chemicals than conventional cigs but not harmless. Can contain heavy metals, volatile organic compounds. Been used to deliver not only nicotine but also THC, CBC, butane hash oils.
3/5
Vaping-induced lung injury
-- Median age 19 (16-53)
-- CAP-like presentation (>80% fever, cough, SOB, WBC >11 w/ PMN)
-- 81% GI ssx (n/v, diarrhea, abdominal pain)
-- 94% hospitalized, 87% received O2, 32% intubation
CXR/CT image:
nejm.org/doi/full/10.10…
4/5
Vaping-induced lung injury
nejm.org/doi/full/10.10…
-- 7/14 BAL specimen w/ lipid-laden macrophages
-- Biopsy: mild inflame to DAD, granulomatous pneumonitis
-- 65% improvement on steroids
5/5
CDC case definition (see pic): cdc.gov/tobacco/basic_…
At our Children’s Hospital, most w/ persistent fever & respiratory distress despite antibiotics.
At present, 530 cases from 38 states in the US.
cdc.gov/tobacco/basic_…
9 deaths reported currently.
5/5 extra/ Another case highlighted by @IncubateMD, see link below
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