Diffuse Lung Disease: Fellow Case Report Poster - Diffuse Lung Disease II |

Is It the E.N.D.S.? FREE TO VIEW

Jonathan Holdorf, MD; Dawn Carpenter, ACNP; Scott Kopec, MD
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University of Massachusetts Medical School, Concord, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):502A. doi:10.1016/j.chest.2016.08.516
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SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Electronic Nicotine Delivery Systems (ENDS) are novel and increasingly popular inhalational devices with a poorly defined safety profile. We describe a case of acute exogenous lipoid pneumonia (LP) in a patient following heavy ENDS use.

CASE PRESENTATION: A 35 year old female at 32.6 weeks gestation presented to the Emergency Department with acute onset of severe dyspnea and chest pain. She had been intermittently using ENDS, or vaping, over the preceding month, but she reported heavy vaping in the hours before presenting to the ED. Her partner had been self-mixing the vaping cartridges with glycerin, vegetable oil and strawberry flavoring. The patient was afebrile, but in respiratory distress with a white blood cell count of 19,300/mm3. Computed tomography (CT) angiography of the chest showed upper lobe predominant ground glass opacities and “crazy paving” (Image 1). She developed worsening hypoxemia requiring high-flow nasal cannula. 24 hours into hospitalization, tocometer revealed uterine contractions, betamethasone was administered and the patient delivered vaginally in the intensive care unit. Respiratory distress improved and oxygen was weaned off within 48 hours following delivery. The patient was discharged home on hospital day #5 and the infant was discharged home in stable condition after 3 weeks.

DISCUSSION: ENDS have been rarely described in association with LP. LP is the result of acute or chronic lipid accumulation in lung tissue from either endogenous or exogenous sources. Clinical presentation ranges from very mild to severe and life-threatening. Chest CT imaging can show diffuse ground glass opacities, “crazy paving” pattern, airspace consolidations, the most specific finding being fat attenuation within consolidations. Bronchoalveolar lavage may show lipid laden macrophages with extracellular oily droplets. Treatment is supportive, with limited data suggesting a benefit to corticosteroid use for severe cases.

CONCLUSIONS: We present a case of acute exogenous lipoid pneumonia due to vaping a homemade solution of propylene glycol, vegetable oil and strawberry flavoring. This case highlights the potential perils of using ENDS and the need to further study the short and long term effects.

Reference #1: Marchiori E, Zanetti G, Mano CM, Hochhegger B. Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med. 2011;105:659-666.

Reference #2: Baron SE, Haramati LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imaging. 2003;18:217-224.

DISCLOSURE: The following authors have nothing to disclose: Jonathan Holdorf, Dawn Carpenter, Scott Kopec

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