Table 2.
Clinical characteristics of vaping cases
| Case Number | 1 | 2 | 3 |
|---|---|---|---|
| Smoking History | Former smoker, 35 PY | Never smoker | Former smoker: cigarettes 0.25packs per day, quit 1.5 years ago; smoke marijuana daily. |
| History of lung diseases | No | No | No |
| Constitutional symptoms | Fever, hot flashes, sweaty, | Fever and chills, significant night sweats, unintentionally weight loss of 18–20lbs over the past week. | Some night sweats, unintentional weight loss of 10lb |
| Duration of disease onset before admission | 5 days | 2 months | 2 months |
| Vital signs | Maximum Temperature 39.1C | Maximum Temperature 38C, Maximum Heart Rate 133 bpm, Maximum Respiratory Rate 53 b/m | Unremarkable |
| Respiratory symptoms | SOB, dry cough, Pleural chest pain (L > R) | Cough, dyspnea | Exertional dyspnea, cough, chest pain when coughing |
| Non-respiratory symptoms | None | Nausea, projectile vomiting, and watery diarrhea | None |
| GI symptoms | None | Yes | None |
| Physical exam | Bibasilar cackles | Diffuse crackles, more pronounced bibasilar, L > R | Diffuse crackles bilaterally, no wheeze |
| Significant Labs | WBC 16.4 k, Na 131 | Na 133, K 3.0, WBC 9.2->17.8 k, | PaO2 68 mmHg, CRP 12 |
| Transaminitis | No LFT results available | AST 35, ALT 53 | Normal AST 19, ALT 22 |
| CXR on admission | Hazy bilateral basilar opacities | Punctate high density over the left upper chest, possible minimal infiltrate at posterior lower lung | Extensive opacities seen throughout bilateral lungs, predominantly throughout the upper lobes and peripheral distribution. Patchy changes seen within the perihilar lower lobes. |
| Chest CT | Enlarged prevascular node (1.2 × 1.8 cm), prominent precarinal LN, prominent Rt hilar LN. Diffuse bilateral GGO | Bilateral infiltrates of somewhat ground-glass in appearance with interstitial and septae, and some precarinal and subcarinal adenopathy. | Scattered ground-glass attenuation with superimposed interlobular septal thickening and areas of confluent airspace opacities bilaterally |
| Infectious Disease Workup | Negative | Negative | Negative |
| Bronchoscopy | Yes | No | No |
| BAL | Negative for malignancy and infection | No | No |
| Biopsy | EBUS: S7: negative for tumor and granuloma. Lingula biopsy: negative bacterial and fungal cultures | No | No |
| Treatment | Antibiotics: ceftriaxone, doxycycline; Steroids: Prednisone 60 mg once a day for 4 days | Antibiotics: Ceftriaxone; Steroids: Methylprednisolone 50 mg twice a day for 4 days, then 40 mg once a day for 1 day; | Antibiotics: Ceftriaxone and azithromycin; Steroids: methylprednisolone 60 mg three times a day for 2 days, prednisone 40 mg with 4 weeks taper |
| Response to treatment | Oxygen demands decreased after steroids X 2d | One day after initiated steroids | One days after initiated steroids |
| Length of hospital stay | 4 days | 6 days | 3 days |
| Primary Dx on admission | Sepsis | Nausea and vomiting due to gastroenteritis | Dyspnea on exertion |
| Primary Dx on discharge | Vaping induced lung injury | Vaping induced lung injury | Pulmonary infiltrates |
Table 1. All three patients had no previous lung disease. Onset of acute symptoms started between 5 days to 2 months prior to admission. One of three patients had neutrophil-dominant leukocytosis. All three patients demonstrated radiologic abnormalities as above. One patient underwent bronchoscopy, bronchoalveolar lavage, and lung biopsy; while macrophages and other inflammatory cells were seen on BAL, no specific underlying pathology was identified. All patients demonstrated symptomatic and radiographic improvement following steroid administration. Abbreviations: BAL - Bronchoalveolar lavage; bpm – beats per minute; b/m - breaths per minute; CT – computed tomography; EBUS - Endobronchial ultrasound; GGO – ground glass opacities; LN – lymphadenopathy; PY – pack years.