Page 31 - Delaware Medical Journal - May/June 2020
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ABSTRACTS
threatening, severe respiratory illness that is thought to be due to harmful chemicals in vape and e-cigarette products. We present this case to further characterize how VAPI may present in the emergent setting and detail our VAPI patient’s clinical course.
Case Description: A 20-year-old female seen at an outside urgent care, complaining of dyspnea on exertion, shortness of breath, intermittent fevers, post-tussive emesis, and decreased PO intake that had persisted for four days. She was treated with Guaifenesin and Alprazolam. Approximately seven days after the onset of these symptoms,
the patient’s mother noticed the patient had cyanotic lips while napping. The patient’s mother decided to bring her to the emergency department. The patient was hypoxic, febrile, and tachypneic on arrival. A Chest CAT scan was obtained and revealed dense bilateral lower-lobe consolidations as well
as bilateral upper and right middle-lobe ground-glass opacities with interstitial of possible multifocal pneumonia, pulmonary edema, and/or acute respiratory distress
syndrome. In the intensive care unit, the
cannula requiring FiO2 up to 100%. She
did not require intubation. The patient was placed on a methylprednisolone taper and completed a course of antibiotics to cover her for superimposed pneumonia. The patient was successfully transitioned to nasal cannula and eventually weaned to room air. She was placed on a seven-week taper of prednisone, the recommended treatment for suspected VAPI. Additionally, the patient was counselled on the importance of vape cessation. Our patient’s vape products have been collected for further analysis.
Discussion: VAPI is an important public health concern and a subject of ongoing investigation. Unfortunately, a large portion of documented vaping-associated pulmonary illnesses has occurred in young adults and teenagers. A recent study investigating VAPI reviewed 53 VAPI patients, and
found a median age of 19.1 As of November 2019, there have been 39 deaths due to VAPI.2 Although no compound has been outbreak, advances indicate Vitamin E
in the pathogenesis of VAPI.2 This case demonstrates the high index of suspicion needed for VAPI diagnosis in patients with acute respiratory failure, given the severity of the illness and lengthy recommended treatment. Although our patient did not require intubation, there should be a low threshold for intubation in VAPI patients; 32% of VAPI patients required intubation in the aforementioned study.
CONTRIBUTOR
■ ErinTorpeyisafourth-yearmedicalstudentat the Rowan College of Osteopathic Medicine.
References:
1. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report. New England Journal of Medicine 2019.
2. “Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products.” Centers for Disease Control and Prevention,
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