Vaping in the Time of COVID
This case highlights some complex clinical decisions presented to physicians in the current climate as well as difficulty in interpreting SARS-Cov2 PCR in relation to clinical presentation.
Abstract
Electronic-cigarette or vaping product use-associated lung injury (EVALI) is a disease of acute respiratory failure related to the use of e-cigarette or vape products. Coronavirus disease 2019 (COVID-19) is a viral infection which primarily affects the lungs and, in some cases, causes acute respiratory failure which can present very similarly clinically to EVALI. Here we present a 25-year-old man with no past medical history who presented to the hospital with a positive SARS-Cov2 test and clinical symptoms of COVID-19. He improved with oxygen and went home. 3 days later his respiratory and GI symptoms returned. He had an outside SARS-Cov2 PCR test which was negative;however, two days later a second PCR was done at our facility which was positive after 40 amplification cycles. Of note, the initial test was positive after 28 amplification cycles. Upon further discussion the patient reported marijuana smoking three times daily and vaping THC throughout the day. He was treated for EVALI and improved rapidly. This case highlights some complex clinical decisions presented to physicians in the current climate as well as difficulty in interpreting SARS-Cov2 PCR in relation to clinical presentation.