Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use

by | Addiction

http://pediatrics.aappublications.org/content/early/2018/05/15/peds.2016-3927

Casey G. Sommerfeld, Daniel J. Weiner, Andrew Nowalk, Allyson Larkin

Abstract

Electronic cigarette (e-cigarette) use, or “vaping,” is gaining widespread popularity as an alternative to conventional cigarettes among adolescents. Little is known of the health risks of e-cigarette use, especially in children and adolescents. We present a Case Report of a previously healthy 18-year-old woman who presented with dyspnea, cough, and pleuritic chest pain after e-cigarette use. She developed respiratory failure with hypoxia and was intubated, and ultimately met diagnostic criteria for acute respiratory distress syndrome. Chest tubes were placed to drain worsening pleural effusions. Computed tomography of the chest revealed dependent opacities in both lung bases, superimposed smooth interlobular septal thickening, and pleural effusions. Bronchoalveolar lavage revealed cellular debris and reactive mononuclear cells, and cell counts were remarkable for elevated mononuclear cells and eosinophilia. After the results of a workup for an infectious etiology came back negative, the patient was diagnosed with hypersensitivity pneumonitis and intravenous methylprednisolone therapy was initiated. After this the patient rapidly improved, was weaned off vasopressor support, and was extubated. This is the first reported case of hypersensitivity pneumonitis and acute respiratory distress syndrome as a risk of e-cigarette use in an adolescent, and it should prompt pediatricians to discuss the potential harms of vaping with their patients. Hypersensitivity pneumonitis, lipid pneumonia, and eosinophilic pneumonia should be included in the differential diagnosis of patients who exhibit respiratory symptoms after the use of an e-cigarette.

 

  • Abbreviations:
    BAL — 
    bronchoalveolar lavage
    CT — 
    computed tomography
    e-cigarette — 
    electronic cigarette

 

Tobacco use remains a significant public health issue in pediatric patients. The use of electronic cigarettes (e-cigarettes), or “vaping,” is gaining widespread popularity as an alternative to conventional cigarettes. Recent data from the National Youth Tobacco survey revealed a threefold increase in e-cigarette use between the years 2011 and 2013 in adolescents without a previous history of smoking.1

Currently there are limited data on the health risks of e-cigarettes in pediatric patients because in previous reports researchers have documented respiratory consequences mostly in the adult population. The youngest patient so far described is a 20-year-old man diagnosed with acute eosinophilic pneumonitis immediately after smoking an e-cigarette. Although he presented with respiratory symptoms, his oxygen saturations remained at 100% on room air and he did not require respiratory support during his admission.2 In another report of a 60-year-old man with a presumptive diagnosis of acute hypersensitivity pneumonitis, this disorder is connected to the use of e-cigarettes. This patient required oxygen supplementation for hypoxemia but, again, no further respiratory support.3 In 2 further reports, researchers describe lipid pneumonia secondary to e-cigarette use, and 1 patient required intubation for acute respiratory distress syndrome.4,5 There are no case reports in the literature in which researchers describe respiratory failure secondary to hypersensitivity pneumonitis as a consequence of e-cigarette use in the pediatric population.

Comment:

Wow! What a steep price to pay for vaping!  I wonder what the incidence of sensitivity for this is in the general population?  No mention of genetic testing for susceptibility, but this is such an extreme and apparently rare case, I suspect that there’s a SNP

Dr. Raymond Oenbrink
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