Via Research Recognition Day 2024 VCOM-Carolinas

Clinical Case-Based Reports

E-cigarette/Vape Associated Lung Injury as a Cause of Interstitial Lung Disease

Kathryn Vess, MA, OMS-IV 1 , Nicole Ivan, OMS-IV 1 , Joseph Boscia, MD 2 1 Edward Via College of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC 2 Spartanburg Regional Healthcare System, Spartanburg, SC

Discussion

Introduction

Imaging

Figure 3: Diagram of an e-cigarette

Case Report SUBJECTIVE • 62-year-old male with one-and-a-half years of worsening dyspnea and chronic nonproductive cough • New supplemental oxygen requirement of 2 L nasal cannula • Past medical history: diffuse large B cell lymphoma in remission. Status post 6 rounds of EPOCH-R • Social history: 35 pack-year, quit smoking cigarettes 10 years ago, daily e-cigarette use of 10 years, no illicit drug use OBJECTIVE Physical Exam • Lungs clear to auscultation. • No fingernail clubbing. • 2+ pitting edema bilaterally. PFTS • Reduced FEV1, FVC, FEV1/FVC • Reduced TLC • Mixed obstructive and restrictive lung disease Bronchoscopy • Hyperemic airways, grossly normal anatomy • Bronchoalveolar lavage negative for eosinophilia or abnormal cytology CT CHEST • Scattered areas of parenchymal scarring throughout lungs, more notable in the upper lobes. Bilateral ground glass opacities. No honeycombing. Pulmonary Wedge Biopsy • Diffuse alveolar damage with eosinophilia E-cigarette/vape associated lung injury (EVALI) refers to any pathologic injury to the lung that occurs because of e-cigarette or vape exposure. This is a diagnosis of exclusion and represents a wide variety of pathologies. EVALI can present with many different symptoms and pathologies. The most common presentation is interstitial lung disease or damage to the lung parenchyma. The most effective treatment across multiple pathologies is e-cigarette cessation and IV corticosteroids.

Figure 1: CT Chest

The vape system consists of a chamber with a coiled metal heating element. This results in inhalation of gas particles 1-2 micrometers in diameter. Commercially available solvents are inherently unsafe to lung parenchyma. Nicotine Carbonyls Heavy metals Bacterial endotoxins Fungal glycans

Benzene Toluene

Vegetable glycerin Propylene glycol

Vegetable glycerin and propylene glycol decompose to form aldehyde, formaldehyde, and acrolein. Diacetyl and 2,3-pentanediol – disrupts cilia of bronchial epithelial cells.

CT Chest which demonstrates bilateral interstitial opacities. Figure 2: Right Open Lung Biopsy

Conclusion

Open lung biopsy is not needed in order to diagnose EVALI. Few lung biopsies of non-THC EVALI exist in the current literature.

References/Acknowledgements

Mike Mikulasovich, DO, (pathology) for analysis of the specimens Amber Stroupe, DO, (IM/PEDS) for help with preparation of this poster for submission

Histological images showing diffuse alveolar damage with eosinophilia (https://webpath.med.utah.edu/LUNGHTML/LUNG133.html)

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2024 Research Recognition Day