Lung Injury from Vaping May Be Misdiagnosed Due To Similarities To Pneumonia: Case Report

As health officials continue to face a growing number of severe respiratory injuries linked to e-cigarettes, including dozens of deaths, researchers warn that it may be difficult for doctors to differentiate vaping lung injuries and pneumonia, potentially leading to misdiagnosis and delays in critical treatment.

According to updated information released earlier this month by the U.S. Centers for Disease Control and Prevention (CDC), at least 2,711 individuals nationwide had been hospitalized or died due to a condition now known as EVALI, which stands for e-cigarette or vaping associated lung injury. Problems have been reported in all 50 states, as well as the District of Columbia and several U.S. territories.

In a recent case analysis published in the Journal of the American College of Emergency Physicians (JACEP) Open, researchers outline one case where the lung injury from vaping was misdiagnosed as pneumonia. As a result, the patient failed to get needed treatment quickly and suffered serious side effects.

The findings have led doctors in the Emergency Medicine Department at Vanderbilt University Medical Center to warn the medical community that the symptoms of e-cigarette lung illness are very similar to pneumonia, indicating that this may cause doctors to confuse one for the other and fail to properly treat vaping lung injury patients.

The case study involved a 20-year-old patient who went into the emergency room with symptoms of shortness of breath, cough, and fever. While these symptoms have been included in recent warnings about the importance of monitoring e-cigarette users for vaping lung injury, emergency room doctors were unfamiliar with the ailment and misdiagnosed the condition as pneumonia.

The patient was hospitalized for four days and eventually left against medical advice. He later returned to the ER complaining of chest pain, fever, diarrhea, nausea, and shortness of breath. He also lost a significant amount of weight.

Researchers warn it is important for doctors to be vigilant about recognizing symptoms of the vaping lung illness and understanding the symptoms can mimic other illnesses.

Part of the process for diagnosing vaping lung illness is ruling out other infections, autoimmune disorders, and other conditions. In this case, tests for strep, HIV, hepatitis and other diseases came back negative. Doctors then inserted a camera into his airway to examine his lungs and conducted a CT scan and were able to confirm vaping lung disease.

As part of a multi-agency investigation in the the vaping lung problems, researchers have suggested that vitamin E acetate and THC used in vaping products may be involved in many of the lung illnesses. However, it is possible other chemicals may also contribute to the lung disease, and the investigations are ongoing.

Nearly one-third of vaping lung injury patients require intubation and mechanical breathing help. A patient’s health can deteriorate rather quickly, so it is important for doctors to keep in mind the widespread nature of vaping lung disease outbreak when evaluating patients with similar symptoms.

In addition, health officials issued a warning earlier this month, indicating the risk of rehospitalization after suffering vaping lung injury was high. About 3% of patients affected by the illness have to return to the hospital, some eventually dying.

“Electronic cigarettes and vaping products are sending thousands of smokers, especially teens, to emergency departments,” said Kaitlyn Works, MD, an emergency physician with Vanderbilt University Medical Center and lead author of the study. “We must be crystal clear with young people: E-cigarettes and vaping products are not a healthy alternative to smoking. They can be dangerous, cause injuries and illnesses, or even death.”

The findings come as a growing number of vaping injury lawsuits continue to be filed against JUUL and the makers of other e-cigarettes, not only involving problems with severe lung damage, but also alleging that the products resulted in life-long nicotine addictions and other injuries.