Case Study
by Ashley Roberts, OMSIII 1 ; sudheer Koyagura, md, mph 2
1
Arkansas College of Osteopathic Medicine, Fort Smith, Ark.
2
Hospitalist Medical Director, Northwest Medical Center,
Adjunct Clinical instructor, NYIT College of Medicine at Arkansas State University;
A Case of Acute Respiratory Failure Due to Vaping
The symptoms and radiological findings related to
these cases have been found to be similar to one
another. The symptoms are usually flu- or pneumonia-like,
including nausea, vomiting, dyspnea,
and coughing. They may vary due to the amount
or type of toxic chemicals that have been inhaled.
Two of the substances in the E-cigarette oil (diacetyl
and 2,3-pentanediol) have been shown to
cause problems with gene expression of cilia in
the airways of patients. 1 A 25-year-old man with a
history of vaping presented with acute respiratory
A 25-year-old male presented to the emergency
room with shortness of breath, nausea, and
vomiting and was diagnosed with left-lower-lobe
pneumonia. He was treated with anti-emetics,
fluids, and Levaquin and was discharged in stable
condition that evening. The following day,
his symptoms of dyspnea, nausea, and vomiting
worsened and he subsequently returned to the
ER. His oxygen saturation on room air was 88%,
and he was tachycardic at 115 beats per minute.
The chest CT showed patchy, bibasilar interstitial
and airspace infiltrates bilaterally, which was
diagnosed as multifocal pneumonia. The patient
was admitted to the hospital and started on IV antibiotics
(IV rocephin and IV zithromax).
Upon questioning, the patient admitted to cigarette
smoking as well as THC-based vaping on a
regular basis. He had been working in a chicken
coop for the past few weeks with exposure to
live animals placing histoplasmosis on the list of
differentials. His main complaints were dyspnea,
coughing, nausea, vomiting, dry heaving, and
pleuritic chest pain. Of note, his nausea and dry
heaving were likely due to THC withdrawal. On
physical examination, crackles were auscultated
bilaterally with decreased chest wall expansion
and diminished breath sounds.
Figure 1. Computed Tomographic Scans of the Chest: A Case of Acute
Respiratory Failure due to Vaping
Abstract
The toxic substances in the oils that are inhaled
with vaping have been found to cause serious
lung injuries in patients across the nation. Here
we present a 25-year-old male who suffered from
respiratory failure from inhalation of these toxic
substances. He was diagnosed based on his imaging
studies and deteriorating clinical presentation.
His symptoms resolved with the addition
of steroids to his treatment regimen. This case is
significant because of the increasing use of E-cigarettes
and vaping in our country right now. The
number of vaping-related deaths is increasing,
and the question of banning e-cigarettes is an ongoing
discussion.
Background
The CDC has reported that vaping-related lung
injuries and deaths have been increasing rapidly. 3
failure and quickly progressing lung injury. The
radiographic images of his lungs show diffused
interstitial and airspace infiltrates, similar to the
other vaping cases recently reported in the New
England Journal of Medicine. 1
Case
After a few days of inpatient care, the patient remained
short of breath and required supplemental
oxygen. Lung imaging had worsened with
time, showing diffused bilateral lung opacities.
After consulting with pulmonology, the patient
was started on IV steroids. Pulmonology also
recommended bronchoscopy, with brushing
biopsy and BAL. The procedure was performed
and Bronchoalveolar lavage (BAL) with brushing
biopsy was obtained from the posterior segment
of the right lower lobe and sent to pathology. Thin
mucus plugging was found in the airways and
subsequently suctioned.
After six days of treatment with IV antibiotics
38 • The Journal of the Arkansas Medical Society www.ArkMed.org