First double lung transplant secondary to suspected e-cigarette vaping-associated lung injury

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Conference Proceeding

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Journal of Medical Toxicology


Background: As of November 13, 2019, the CDC has confirmed 2172 cases of E-cigarette vaping-associated lung injury (EVALI): 70% in males, 86% involving THC, and 64% involving nicotine. Although there have been 42 deaths, this is the first reported lung transplant in an EVALI patient. Methods: This is a single case review. Results: A 16-year-old white male presented to the ED for dyspnea and cough with history of vaping. He was admitted to "hospital #1" and treated with antibiotics for suspected pneumonia. Additional history revealed use of self-created THC products containing vitamin E. On hospital day 4, he was transferred to the pediatric ICU for worsening hypoxemia and placed on steroids for suspected EVALI. On hospital day 6, he was intubated due to persistent hypoxia and worsening respiratory status. An extensive infectious and inflammatory evaluation was negative. Lung cytology from BAL did not reveal lipid-laden macrophages or other pathology. Due to worsening respiratory status, he was transferred to "hospital #2" for veno-venous ECMO on hospital day 11. The remainder of organ function was normal. Despite multiple attempts to wean from ECMO, lung function showed no signs of improvement, and he was referred to "hospital #3" for lung transplant. After 27 days on ECMO (hospital day 39,) he received a double lung transplant for irreversible lung damage and accumulating barotrauma. The patient is now off EMCO, has a tracheostomy, and is neurologically intact. He is able to speak and is undergoing intensive rehabilitation. Conclusion: Although most cases of EVALI survive and most often show improvement temporally related to steroid administration, EVALI can be relentless and lead to severe lung injury and death. This patient suffered irreparable lung damage despite early presentation, steroids, and early ECMO. Lung transplant can be considered a viable option for severe and refractory cases.





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