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

pediatric acute respiratory distress syndrome - hypersensitivity pneumonitis - electronic cigarette

• References

• 1 Centers for Disease Control and Prevention. Tobacco use in youth is rising: E-cigarettes are the main reason. Available at: https://www.cdc.gov/vitalsigns/youth-tobacco-use . Accessed September 18, 2019
• 2 Wild LG, Lopez M. Hypersensitivity pneumonitis: a comprehensive review. J Investig Allergol Clin Immunol 2001; 11 (01) 3-15
• 3 Rom O, Pecorelli A, Valacchi G, Reznick AZ. Are E-cigarettes a safe and good alternative to cigarette smoking?. Ann N Y Acad Sci 2015; 1340: 65-74
• 4 Cheifetz IM. Year in review 2015: pediatric ARDS. Respir Care 2016; 61 (07) 980-985
• 5 Ranieri VM, Rubenfeld GD, Thompson BT. , et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307 (23) 2526-2533
• 6 Bernard GR, Artigas A, Brigham KL. , et al; The Consensus Committee. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Intensive Care Med 1994; 20 (03) 225-232
• 7 Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) 428-439
• 8 Hough RF. Recent advances in pediatric acute respiratory distress syndrome. Curr Pediatr Rep 2017; 5 (04) 228-236
• 9 Schouten LR, Veltkamp F, Bos AP. , et al. Incidence and mortality of acute respiratory distress syndrome in children. Crit Care Med 2016; 44 (04) 819-829
• 10 Wang J, Loh SW, Lee JH. Paediatric acute respiratory distress syndrome: progress over the past decade. J Emerg Crit Care Med 2018; 2: 24
• 11 Rouby JJ, Brochard L. Tidal recruitment and overinflation in acute respiratory distress syndrome: yin and yang. Am J Respir Crit Care Med 2007; 175 (02) 104-106
• 12 Hubmayr RD. Perspective on lung injury and recruitment: a skeptical look at the opening and collapse story. Am J Respir Crit Care Med 2002; 165 (12) 1647-1653
• 13 Cavalcanti B, Suzumura EA, Laranjeira LN. , et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs. low PEEP on mortality in patients with acute respiratory syndrome: a randomized clinical trial. JAMA 2017; 318 (14) 1335-1345
• 14 Lopez M, Salvaggio JE. Epidemiology of hypersensitivity pneumonitis/allergic alveolitis. Monogr Allergy 1987; 21: 70-86
• 15 Richerson HB, Bernstein IL, Fink JN. , et al. Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. J Allergy Clin Immunol 1989; 84 (5 Pt 2): 839-844
• 16 Ishizuka M, Miyazaki Y, Tateishi T, Tsutsui T, Tsuchiya K, Inase N. Validation of inhalation provocation test in chronic bird-related hypersensitivity pneumonitis and new prediction score. Ann Am Thorac Soc 2015; 12 (02) 167-173
• 17 Selman M. Hypersensitivity pneumonitis. In: Schwarz MI, King Jr TE. , eds. Interstitial Lung Disease, 5th ed. Shelton, CT: People's Medical Publishing House; 2011: 597
• 18 Girard M, Lacasse Y, Cormier Y. Hypersensitivity pneumonitis. Allergy 2009; 64 (03) 322-334
• 19 Hirschmann JV, Pipavath SN, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2009; 29 (07) 1921-1938
• 20 Ohtani Y, Saiki S, Sumi Y. , et al. Clinical features of recurrent and insidious chronic bird fancier's lung. Ann Allergy Asthma Immunol 2003; 90 (06) 604-610
• 21 Schuyler M, Cormier Y. The diagnosis of hypersensitivity pneumonitis. Chest 1997; 111 (03) 534-536
• 22 Guillerman RP. Imaging of childhood interstitial lung disease. Pediatr Allergy Immunol Pulmonol 2010; 23 (01) 43-68
• 23 Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE. Hypersensitivity pneumonitis: current concepts. Eur Respir J Suppl 2001; 32: 81s-92s
• 24 Cottin V, Cordier JF. Eosinophilic lung diseases. Immunol Allergy Clin North Am 2012; 32 (04) 557-586
• 25 Uchiyama H, Suda T, Nakamura Y. , et al. Alterations in smoking habits are associated with acute eosinophilic pneumonia. Chest 2008; 133 (05) 1174-1180
• 26 Rhee CK, Min KH, Yim NY. , et al. Clinical characteristics and corticosteroid treatment of acute eosinophilic pneumonia. Eur Respir J 2013; 41 (02) 402-409
• 27 Allen JN, Pacht ER, Gadek JE, Davis WB. Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure. N Engl J Med 1989; 321 (09) 569-574
• 28 Allen JN, Liao Z, Wewers MD, Altenberger EA, Moore SA, Allen ED. Detection of IL-5 and IL-1 receptor antagonist in bronchoalveolar lavage fluid in acute eosinophilic pneumonia. J Allergy Clin Immunol 1996; 97 (06) 1366-1374
• 29 Kuschner WG, D'Alessandro A, Wong H, Blanc PD. Dose-dependent cigarette smoking-related inflammatory responses in healthy adults. Eur Respir J 1996; 9 (10) 1989-1994
• 30 Jenssen BP, Walley SC. ; SECTION ON TOBACCO CONTROL. E-cigarettes and similar devices. Pediatrics 2019; 143 (02) e20183652
• 31 Kokkarinen JI, Tukiainen HO, Terho EO. Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung. Am Rev Respir Dis 1992; 145 (01) 3-5
• 32 Selman M, Pardo A, King Jr TE. Hypersensitivity pneumonitis: insights in diagnosis and pathobiology. Am J Respir Crit Care Med 2012; 186 (04) 314-324
• 33 Wiatr E, Radzikowska E, Pawłowski J. Pulmonary fibrosis in young patients with hypersensitivity pneumonitis [in Polish]. Pneumonol Alergol Pol 2004; 72 (3-4): 111-116
• 34 Modi S, Sangani R, Alhajhusain A. Acute lipoid pneumonia secondary to E-cigarette use: an unlikely replacement for cigarettes. Chest 2015; 148 (4_Supplement): 382A
• 35 McCauley L, Markin C, Hosmer D. An unexpected consequence of electronic cigarette use. Chest 2012; 141 (04) 1110-1113
• 36 Viswam D, Trotter S, Burge PS, Walters GI. Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Case Rep 2018; 2018: bcr-2018-224350
• 37 Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. AJR Am J Roentgenol 2010; 194 (01) 103-109
• 38 Battistini E, Dini G, Savioli C. , et al. Bronchiolitis obliterans organizing pneumonia in three children with acute leukaemias treated with cytosine arabinoside and anthracyclines. Eur Respir J 1997; 10 (05) 1187-1190
• 39 Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics 2013; 33 (07) 1951-1975
• 40 US Food and Drug Administration. The facts on the FDA's new tobacco rule. Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm506676.htm . Accessed September 8, 2019
• 41 US Food and Drug Administration. Statement from FDA commissioner Scott Gottlieb, MD on pivotal public health step to dramatically reduce smoking rates by lowering nicotine in combustible cigarettes to minimally or non-addictive levels. Available at: https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-pivotal-public-health-step-dramatically-reduce-smoking . Accessed September 8, 2019
• 42 Office of the Commissioner C for TP. Press Announcements – Statement from the FDA Commissioner Scott Gottlieb, MD., on proposed new steps to protect youth by preventing access to flavored tobacco products and banning menthol in cigarettes. 2018 . Available at: https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-proposed-new-steps-protect-youth-preventing-access . Accessed September 8, 2019
• 43 Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. 2018 . Available at: https://www.cdc.gov/statesystem/index.htm . Accessed September 8, 2019
• 44 King BA, Gammon DG, Marynak KL, Rogers T. Electronic cigarette sales in the United States, 2013-2017. JAMA 2018; 320 (13) 1379-1380
• 45 Centers for Disease Control and Prevention. Adams Jones. “Surgeon General's Advisory on E-Cigarette Use Among Youth.” Know the Risks: E-Cigarettes & Young People, 2018 . Available at: https://e-cigarettes.surgeongeneral.gov . Accessed September 18, 2019
• 46 Wyckoff A. Addiction expert offers insight on screening for E-cigarette use. AAP. Available at: https://www.aappublications.org/news/2018/11/05/nce18plenary1110518 . Accessed September 8, 2019
• 47 American Academy of Pediatrics. AAP Policy Statement: E-cigarettes need stronger regulations to prevent youth access and use. Available at: https://www.healthychildren.org/English/news/Pages/E-Cigarettes-Need-Stronger-Regulations.aspx . Published January 28, 2019. Accessed September 8, 2019
• 48 US Food and Drug Administration. The Real Cost Campaign. 2019 . Available at: https://www.fda.gov/tobacco-products/public-health-education-campaigns/real-cost-campaign#1 . Accessed September 8, 2019
• 49 American Lung Association. Stop Smoking. “Helping Teens Quit”. 2019 . Available at: https://www.lung.org/stop-smoking/helping-teens-quit/ . Accessed September 8, 2019