A Teen With Cough: Could This Be Vaping Related?

Susan Adkins, MD; Mark Layer, MD; Emily Koumans, MD


December 13, 2019

Editorial Collaboration

Medscape &

Patients with suspected EVALI should be admitted if they have decreased oxygen saturation (< 95%) on room air, are in respiratory distress, or have comorbidities that compromise pulmonary reserve. John is admitted with diagnoses of possible pneumonia and possible EVALI, and oxygen is continued.

An influenza molecular assay is obtained. Blood and sputum cultures are obtained, empiric antibiotics are initiated, and antivirals are continued. An infectious disease specialist is also consulted. Hospitalization is common among patients with EVALI; among cases reported to CDC with available data on hospitalization, as of November 5, 2019, 95% of patients were hospitalized.

Additional testing is ordered on the basis of published guidelines for evaluation of community-acquired pneumonia. Infectious etiologies considered by the team include Streptococcus pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, endemic mycoses, and opportunistic infections. Other abnormal laboratory test results reported in patients with EVALI include elevated white blood cell count, serum inflammatory markers (C-reactive protein, erythrocyte sedimentation rate), and liver transaminases. However, at this time, these tests cannot be used to distinguish EVALI from infectious etiologies. In all patients, providers should consider conducting—with informed consent—urine toxicology testing, including testing for THC.

Case Conclusion: Increasing Complications and Resolution

Unfortunately, John's respiratory status continues to deteriorate; he requires increasing amounts of oxygen to maintain saturation above 95%.