SESSION TITLE: Diffuse Lung Disease Global Case Reports
SESSION TYPE: Global Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: INTRODUCTION: E-cigarette usage has become a popular smoking alternative, but its potential adverse health effects are poorly understood. We present a patient with no significant past medical history who developed hypersensitivity pneumonitis due to e-cigarette use
CASE PRESENTATION: A 23-year-old morbidly obese male patient with no significant past medical history presented to the Emergency Department with worsening productive cough with rust colored sputum and shortness of breath. The patient admitted to using an e-cigarette device for the last six months. Vital signs showed the patient to be tachypnic, tachycardic, and febrile. There were crackles heard in the right lung field.The patient’s WBC was 9.3 K/µL and his electrolytes and liver enzymes were within normal limits. The patient was started on nebulizer treatments and antibiotics for suspected community acquired pneumonia. Computer tomography (CT) scan of the chest showed countless patchy nodular parenchymal opacities, widely distributed throughout the lungs. Patient underwent fiber optic bronchoscopy; BALF cultures were negative. BAL cell count and differential showed 80% lymphocytes, which is universally noted in most cases of hypersensitivity pneumonitis. Tuberculin skin test, fungal serologies, autoimmune panels, ANCA serologies and HIV titer were also negative. ACE level was normal. Transbronchial biopsy of the left and right lungs exhibited noncaseating epithelioid granulomas. The patient was thus diagnosed with acute hypersensitivity pneumonitis due to e-cigarette aerosol exposure. The patient improved rapidly with cessation of e-cigarette usage and steroid treatment, and was discharged home.
DISCUSSION: Adverse effects associated with e-cigarette usage and aerosol exposure are not well understood. Studies have linked e-cigarette “vaping” sessions to onset of eosinophilic and lipoid pneumonia, as well as sub-acute bronchiolitis. Furthermore, e-cigarette aerosols have been identified as inducing pro-inflammatory mediators in human lung tissue and mouse models. There is paucity of data implicating E-cigarette use with significant lung disease. Patient’s flu-like symptoms, atypical radiological findings, bronchoscopic finding and lung biopsy, results were all consistent with hypersensitivity pneumonitis (HP). Patient rapid improvement with cessation of vaping supports the clinical diagnosis. We are unaware of any previous association between HP onset and E-cigarette use.
CONCLUSIONS: E-cigarette use has been increasing rapidly as means to quit smoking. There are many different manufacturers producing many different flavored juices for vaping. FDA does not regulate these products. There have been some confirmed reports of lung disease associated with E-cigarette use. We present a confirmed case of hypersensitivity pneumonitis associated with vaping. It’s likely that many more cases exist which has not come to clinical attention. There is need for further investigation in the pathogenesis of lung disease associated with E-cigarette use. There is also need to regulate these products because of safety concerns associated with there use.
Reference #1: Reference #1: Orellana-Barrios MA, Payne D, Mulkey Z, Nugent K, Electronic cigarettes-a narrative review for clinicians, The American Journal of Medicine (2015), doi: 10.1016/j.amjmed.2015.01.033
Reference #2: Reference #2: Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, et al. (2015) Vapors Produced by Electronic Cigarettes and E-Juices with Flavorings Induce Toxicity, Oxidative Stress, and
DISCLOSURE: The following authors have nothing to disclose: Rajeev Narang, Devina Narang, Shreya Narang, justin salman, Nhu Quyen, George Udeani
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