Table 4.

Exposure History and Clinical Characteristics of Three Patients with Probable Diagnosis of EVALI without Evidence of Vitamin E Acetate in BAL Fluid.^*

Variable	Patient 1	Patient 2	Patient 3
Patient-reported exposure history	Reported vaping nicotine products, denied vaping THC products	Reported daily vaping of flavored nicotine products obtained from vape shop starting 1 mo before admission, denied vaping THC products	Incomplete interview with the patient; vaping materials found at the scene by first responders; patient later reported heavy alcohol use immediately before illness
Symptoms	Respiratory, gastrointestinal	Constitutional, respiratory	Constitutional, respiratory
Medical history	Negative for chronic respiratory disease and heart disease	Negative for chronic respiratory disease and heart disease	Negative for chronic respiratory disease and heart disease
Presentation	Found unresponsive; on arrival at emergency department, hemoptysis and cyanosis; was intubated and admitted	Presented to urgent care on day of illness (DOI) 1 and to emergency department on DOI 3 and 5, when he was admitted	Found unresponsive; on arrival at emergency department, severe respiratory failure; was intubated and admitted
Admitted to intensive care unit	Yes	No	Yes
Respiratory support	Mechanical ventilation	None	Mechanical ventilation
Radiologic assessment	Hazy opacities predominantly in left lung on radiography; no CT	Bilateral patchy opacities on radiography; diffuse bilateral nodular opacities with surrounding micronodular and ground-glass opacities on CT	Bilateral infiltrates and opacities on radiography and CT
Infectious diseases workup	Blood cultures negative; methicillin-susceptible Staphylococcus aureus (interpreted by clinical team as a contaminant) in BAL fluid	Serologic analysis on admission indeterminate for coccidioides species, follow-up IgM and IgG by immunodiffusion were positive; BAL cell count, 31% eosinophils; negative results on respiratory viral panel, influenza PCR, blood cultures, legionella urinary antigen, Streptococcus pneumoniae urinary antigen, Mycoplasma pneumoniae PCR, cytomegalovirus PCR, pneumocystis antigen, fungal stain and culture, AFB smear, and mycobacterial culture	Negative results on respiratory viral panel, influenza testing, and blood cultures; methicillin-susceptible S. aureus (interpreted by clinical team as a contaminant) in tracheal-aspirate culture
Treatment	Glucocorticoids and antibiotics	Glucocorticoids, antibiotics, and antifungal agents	Glucocorticoids and antibiotics
Disposition	Discharged 3 days after admission	Discharged 3 days after admission	Discharged 13 days after admission
Discharge diagnoses	Unintentional multidrug overdose with benzodiazepines and oxycodone, active nicotinism with vaping, with suspected likely vaping-induced lung injury	Acute eosinophilic pneumonia, initially attributed to EVALI; after discharge, positive results on coccidioides serologic analysis prompted updating of diagnosis to coccidioidomycosis with or without EVALI	Acute hypoxic respiratory failure caused by vaping-associated lung injury, methicillin-susceptible S. aureus pneumonia, acute respiratory distress syndrome, distributive shock

^*AFB denotes acid-fast bacilli, BAL bronchoalveolar lavage, and CT computed tomography.