E-cigarette or vaping product use associated lung injury in the time of
COVID-19: A clinical dilemma
AIM: To report on the clinical, laboratory and radiological findings of
adolescents who presented during the SARS-CoV-2 surge with symptoms of
COVID-19, did not test positive for the infection and were diagnosed
with e-cigarette and vaping product use associated lung injury (EVALI).
Methods: A retrospective review of 12 cases of EVALI admitted to the
Bristol Meyers Squibb Children’s Hospital between February 2020 and June
2020 was conducted. Results: The ages of the patients ranged from 14 to
19 years. There were 6 males and 6 females. Three patients had a past
history of anxiety, depression or other psychiatric/mental health
disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and
eleven had elevated inflammatory markers. Eleven needed respiratory
support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for
IgG Antibodies and were negative. As these cases were admitted to rule
out COVID infection, initial treatment included hydroxychloroquine.
Steroids were started only after SARS-CoV-2 PCR was shown to be
negative. Urine THC was positive in all cases. CXR and CT findings
showed ground glass opacities. CONCLUSIONS: Clinical and radiological
features are similar in both EVALI and SARS-CoV-2 infection.
Inflammatory markers are elevated in both conditions. A detailed social
and substance use history in patients presenting with ‘typical’ COVID
pneumonia like illness is important. EVALI should be ruled in early to
start the appropriate treatment. Given the ongoing pandemic,
pediatricians and other health care providers need to be aware of other
conditions that can masquerade as SARS-CoV-2.