Prague Med. Rep. 2023, 124, 283-292

Vaping Associated Acute Eosinophilic Pneumonia: A Clinical and Radiologic Mimicker of COVID-19

Alyssa Bonnier1, Anum Nida2, Woon Hean Chong3, Santu Saha4, Biplab K. Saha5

1Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, Saint Louis, USA
2Department of Medicine, Ozarks Medical Center, West Plains, USA
3Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
4Department of Medicine, Saha Clinic, Lohagara, Narail, Bangladesh
5Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, USA

Received October 27, 2022
Accepted August 17, 2023

Acute eosinophilic pneumonia (AEP) is a rare cause of respiratory failure. It is primarily a disease of smokers, either a new smoker or an existing one with a recent increase in cigarette consumption. Other risk factors include toxic gas exposure, inhalational illicit drugs, and smoking marijuana. AEP has also been reported in patients with e-cigarette or vaping associated lung injury (EVALI). We present the case of a 20-year-old male who presented to the hospital with acute respiratory failure. The patient has been vaping heavily for the past three months and started smoking three days before presenting to the emergency department. He was hypertensive, tachycardic, tachypneic, and required high-flow nasal cannula to maintain SpO2 > 92%. His condition deteriorated in the first 24 hours following hospitalization requiring noninvasive positive pressure ventilation. Bronchoalveolar lavage revealed an eosinophil count of 36%. Bronchoalveolar lavage (BAL) cytology revealed lipid-laden macrophages. He was diagnosed with AEP due to EVALI, and the patient was treated with high dose corticosteroid with subsequent improvement. Before the bronchoscopic evaluation, the clinical and radiologic findings were consistent with COVID-19, and the patient was tested twice for SARS-CoV-2 PCR. In the appropriate clinical setting, AEP should be considered in the differential diagnoses of community-acquired pneumonia, acute respiratory distress syndrome (ARDS), and COVID-19, especially in this pandemic era.


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