| Titre : |
Vaping-induced secondary organizing pneumonia versus e-cigarette or vaping product usa-associated lung injury (evali) : different spectrum of the same entity? |
| Type de document : |
document électronique |
| Auteurs : |
Sameer M. Javed, Auteur ; Sina Moridzadeh, Auteur ; Fernando Fuentes, Auteur |
| Editeur : |
American College of Chest Physicians |
| Année de publication : |
2023 |
| Collection : |
Chest, ISSN 0012-3692 num. 164 |
| Importance : |
2 p. |
| Langues : |
Anglais (eng) |
| Catégories : |
[TABAC] CANDIDATS:e-cigarette
[TABAC] tabagisme:pathologie:pathologie respiratoire
|
| Index. décimale : |
TA 1.1.1 Cigarettes (« normales », électroniques, aromatisées,…) |
| Résumé : |
INTRODUCTION:
Cryptogenic Organizing Pneumonia (COP) is a form of interstitial lung disease characterized histologically by patchy filling of alveoli and bronchioles with loose plugs of connective tissue, termed Masson bodies. Secondary organizing pneumonia (SOP) is defined when there is an identified cause (1). Vaping-induced SOP is not extensively defined in literature, with e-cigarette or vaping use-associated lung injury (EVALI) in the differential diagnosis, it is difficult to distinguish EVALI from vaping-induced SOP due to overlapping clinical, radiologic, and histopathologic findings with the provocative thought that they could be the same entity but a different spectrum of the disease? In this case report, we present such a diagnostic challenge and
dilemma.
CASE PRESENTATION:
A 36-year-old woman who presented with 2 weeks of shortness of breath, wheezing, cough, malaise/ fatigue, ageusia and congestion, progressed to acute hypoxic respiratory failure requiring admission. Social history was significant for a pet cockatiel, 1 pack-year history, and recent new use of THC vaporizer roughly 5 weeks prior to admission. An extensive work up was negative including COVID-19, respiratory viral panel, fungal and connective tissue disease panels, and hypersensitivity pneumonitis studies. A CTA chest showed scattered patchy ground glass pulmonary infiltrates (Figure 1). Bronchoscopy showed dynamic airway collapse of distal trachea, diffuse erythema, mild edema of all airway mucosa, and degenerated mixed inflammation and mucoid debris. Histology also showed fibroblastic tissue within the airspace consistent with organizing pneumonia as well as a focus of chronic inflammation (Figure 2). No lipid-laden macrophages were seen.
DISCUSSION:
The number of vape consumers is continually increasing, with the e-cigarette market projected to reach 104.51 billion US dollars by 2028 (2). However, with the rise of the COVID-19 pandemic, the incidence or reports of vaping-related pulmonary disease decreased substantially following its peak in September 2019. The CDC decided to discontinue the collection of EVALI case reports in February 2020, this in turn has caused a paucity in literature regarding vaping-related pulmonary disease. Although differentiating vaping-induced SOP and EVALI can diagnostically be difficult, a distinction can be made with presence of lipid-laden macrophages (LLM) on biopsy findings seen in greater than 80% of patients with EVALI as well as the presence of
gastrointestinal (GI) symptoms seen in 90% of patients during EVALI's clinical course according to the literature (3). Our case therefore was defined as vaping-induced SOP, but it seems hard to ignore that this could represent the same entity with a different spectrum of the disease.
CONCLUSIONS:
Algorithmic approaches to COP have been proposed in the literature (1). However, a good quality evidencebased process to the diagnosis of EVALI is lacking in this setting. Although our patient's presentation and work-up was more consistent with the diagnosis of vaping-induced SOP, the gray area between COP, SOP, and EVALI necessitates further research as the use of vaping devices continues to rise. |
| En ligne : |
http://dx.doi.org/10.1016/j.chest.2023.07.2151 |
| Format de la ressource électronique : |
Article en ligne |
| Permalink : |
https://biblio.fares.be/opac_css/index.php?lvl=notice_display&id=10276 |
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Vaping-induced secondary organizing pneumonia versus e-cigarette or vaping product usa-associated lung injury (evali) (2023)
