SHM Converge Scientific Abstract ePoster Gallery-E-Cigarette or Vaping Product Use-Associated Lung Injury Beyond Youth: A Case of Rapid-Onset Respiratory Failure in an Older Female

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This report describes an atypical case of e-cigarette or vaping product use-associated lung injury (EVALI) in a 62-year-old woman, highlighting that this condition is not limited to young males. EVALI became a major public health issue during the 2019 CDC outbreak, and it can resemble pneumonia, COVID-19, or other causes of acute respiratory illness.<br /><br />The patient had a history of diabetes, hypertension, hyperlipidemia, cirrhosis, coronary artery disease, and prior smoking. She presented with sudden shortness of breath, chest pain, and abdominal discomfort, and was found to be hypoxic and tachypneic. Her labs showed inflammation, including elevated white blood cells, CRP, ESR, and LDH, while procalcitonin remained low. Chest CTA demonstrated extensive bilateral ground-glass opacities, especially in the upper lobes.<br /><br />Her respiratory status rapidly worsened within 24 hours, requiring high-flow oxygen. She was initially treated for presumed community-acquired pneumonia with ceftriaxone and azithromycin, but infection became less likely because she had no fever, negative cultures, and persistently low procalcitonin. A broader workup for autoimmune and other causes was unrevealing. Further history revealed that she had switched from smoking to vaping one week before symptom onset, supporting EVALI as the diagnosis.<br /><br />Treatment with intravenous corticosteroids led to marked improvement within 72 hours, and follow-up imaging showed substantial resolution of the lung infiltrates. She was discharged after six days on a prednisone taper and received smoking cessation counseling.<br /><br />The case emphasizes the need for clinicians to consider EVALI in patients with acute hypoxia and bilateral pulmonary infiltrates, especially when recent vaping exposure is identified. Early steroid therapy can lead to rapid recovery, and increased awareness is important as vaping use continues to rise.

Asset Subtitle

Rodwan Jomaa

Meta Tag

Author List Alba L. Caceres Munoz, Ana Chavez Velasquez, Maher Taha, Parminder Deo, Rodwan Jomaa, Scott M. Keeney

Category Clinical Vignettes

Concept E-cigarette or Vaping-Associated Lung Injury

Concept Hypoxemic Respiratory Failure

Concept Ground-Glass Opacities

Concept Diagnosis of Exclusion

Concept Glucocorticoid Therapy

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Rodwan Jomaa

Track Adult

Keywords

EVALI

e-cigarette

vaping

acute respiratory illness

ground-glass opacities

hypoxia

corticosteroids

pneumonia mimic

bilateral infiltrates

smoking cessation

E-cigarette or Vaping-Associated Lung Injury

Hypoxemic Respiratory Failure

Ground-Glass Opacities

Diagnosis of Exclusion

Glucocorticoid Therapy