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• W3092860059 abstract "SESSION TITLE: Medical Student/Resident Tobacco Cessation and Prevention Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Electronic Cigarette Vaping Associated Lung Injury (EVALI) is a new disease whose incidence has been increasing over the last year. A clear etiology has not been identified but there are speculations that it could be related to chemicals used in THC oil pods. New reports of dramatic inflammatory marker shifts in patients with EVALI gives hope that diagnosis and prognosis can be made more efficiently. CASE PRESENTATION: We present a case of a 38-year-old male with a past medical history of asthma and Roux-en-Y gastric bypass secondary to morbid obesity coming into the hospital with productive cough, subjective fever, dyspnea and generalized malaise for the past week. Social history was positive for vaping THC pods. Chest x ray was suggestive of multilobar pneumonia. CT chest revealed diffuse ground glass opacities and multilobar consolidations. Infectious work up was negative. Labs were significant for iron deficiency anemia, low albumin, and elevated ESR and CRP. Platelets were elevated to 845,000. Rheumatologic panel was also negative. Initial treatment with azithromycin for 4 days did not improve symptoms. The patient was placed on ceftriaxone and doxycycline to treat empirically for bacterial pneumonia. BAL was negative for any organisms and bronchoscopy showed a pristine airway and lung tissue. Diagnosis of EVALI was made based on negative infectious, hematologic and rheumatologic work up, positive vaping history, and ground glass opacities on pulmonary CT. Antibiotics were discontinued and the patient was placed on prednisone taper for one month. Two weeks after discharge laboratory abnormalities resolved, and at 4 weeks a repeat chest CT was normal. Patient also reported dramatic clinical improvement after 2 weeks of steroids and vaping cessation. DISCUSSION: Electronic Cigarette Vaping Associated Lung Injury (EVALI) is a diagnosis of exclusion. Presentations have differed in severity, both clinically and chemically with no standard presentation found to date. To our knowledge, there have not been any reported cases with such dramatic shifts in multiple acute phase reactants such as elevated ESR and CRP, iron deficiency anemia, hypoalbuminemia, and thrombocytosis. Supportive care is the mainstay treatment although steroids have proven beneficial for some patients. Doses are not clear as some patients have had resolution of symptoms with high dose pulse steroids, others with orally administered low dose steroids. There have been reports that patients improve with cessation of vaping alone. CONCLUSIONS: Morbidity and mortality of EVALI varies from case to case. There are no clear diagnostic or treatment guidelines as of yet and presentation is extremely variable. Shifts in acute phase reactants may be useful as prognostic indicators in the future. However, the best tool at this time continues to be a detailed history and physical with special emphasis on social history. Reference #1: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products | Electronic Cigarettes | Smoking & Tobacco Use | CDC. Accessed May 31, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html Reference #2: Kligerman S, Raptis C, Larsen B, et al. Radiologic, pathologic, clinical, and physiologic findings of electronic cigarette or vaping product use-associated lung injury (EVALI): Evolving knowledge and remaining questions. Radiology. 2020;294(2):491-505. Reference #3: Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report. New England Journal of Medicine. 2020;382(10):903-916. doi:10.1056/NEJMoa1911614 DISCLOSURES: No relevant relationships by Francheska Castro, source=Web Response No relevant relationships by Jorge Restrepo, source=Web Response No relevant relationships by Varsha Suresh, source=Web Response" @default.
• W3092860059 created "2020-10-22" @default.
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• W3092860059 date "2020-10-01" @default.
• W3092860059 modified "2023-09-27" @default.
• W3092860059 title "E-CIGARETTE VAPING-ASSOCIATED LUNG INJURY: THERE IS ALWAYS MORE TO LEARN" @default.
• W3092860059 doi "https://doi.org/10.1016/j.chest.2020.08.2004" @default.
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