The use of an electronic cigarette or a vaping product Associated Lung Injury (EVALI) in the Times of COVID-19: A Clinical Dilemma – Helfgott – – Pediatric Pulmonology


To report on the clinical, laboratory and radiological findings of adolescents who presented symptoms of COVID-19 during the SARS-CoV-2 flare, did not test positive for infection and were diagnosed with an injury lung disease associated with the use of electronic cigarettes and vaping products (EVALI).


A retrospective review of 12 EVALI cases admitted to Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted.


The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a history of anxiety, depression or other psychiatric / mental health disorders, nine had a prolonged coagulation profile (PT, PTT and / or INR) and eleven had elevated inflammatory markers. Eight needed respiratory assistance. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. The steroids were not started until after the SARS-CoV-2 PCR was negative. Urinary THC was positive in all cases. CXR and CT results showed frosted glass opacities.


Clinical and radiological features are similar in EVALI and SARS-CoV-2 infections. The inflammatory markers are elevated under both conditions. A detailed history of society and substance use in patients with “typical” COVID pneumonia-like illness is important. EVALI must be administered early to start appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers should be aware of other conditions that can pose as SARS-CoV-2.

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