Pediatric Acute Respiratory Distress Syndrome and Hypersensitivity Pneumonitis Related to E-cigarette Vaping

Abstract

In recent years, electronic cigarettes (e-cigs) have been falsely advertised as safe alternatives to conventional smoking. We report a case involving a 16-year-old female who presented with fever, nonproductive cough, and shortness of breath after vaping e-cig/tetrahydrocannabinol dab pen. Her symptoms rapidly deteriorated and met diagnostic criteria for pediatric acute respiratory distress syndrome. Chest radiograph revealed extensive patchy airspace disease and computed tomography scan showed bilateral ground glass opacities. Bronchoalveolar lavage fluid revealed increased neutrophils, lymphocytosis, but absent eosinophilia. After the results of a comprehensive workup for infectious etiology returned negative, she was diagnosed with hypersensitivity pneumonitis and started on systemic corticosteroids.

Keywords: electronic cigarette; hypersensitivity pneumonitis; pediatric acute respiratory distress syndrome.

Fig. 1

( A ) Initial chest radiograph revealed bilateral lower lobes pneumonia. ( B ) Radiograph on day 1 of admission showed worsening patchy airspace opacities. ( C ) Radiograph on day 2 of admission revealed more extensive patchy airspace disease in the bilateral lung bases.

Fig. 2

Computed tomography scan of chest showed smooth interlobular septal thickening ( white arrows ), bilateral interstitial infiltrates, and ground glass opacities ( black arrow ).