Treatment of electronic cigarette or vaping product use-associated lung injury (EVALI) by corticosteroid and low-dose pirfenidone: Report of a case
Journal
Respirology case reports
Journal Volume
9
Journal Issue
10
Date Issued
2021-10
Author(s)
Abstract
Electronic (e)-cigarette or vaping product use-associated lung injury (EVALI) is a novel and potentially lethal disease first reported in the United States. We report the case of a 56-year-old man who presented to our hospital with dyspnoea and cough lasting for 2 months after using an e-cigarette for approximately 50 puffs over 2 weeks. Physical examination revealed crackles in the left lower lung. High-resolution computed tomography (HRCT) showed consolidation and ground-glass opacities in both lungs. The baseline forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were 65.7% and 63.9% of the predicted, respectively. Lung biopsy revealed organizing pneumonia with focal fibrosis. In addition to prednisolone, he was treated with a low-dose pirfenidone (200 mg three times per day) due to the persistence of a mild cough, exertional dyspnoea and basal crackles after discharge. His symptoms and FVC significantly improved, but the recovery of the DLCO was slow. The follow-up HRCT demonstrated only minimal fibrotic changes. To our knowledge, this was the first reported case of EVALI successfully treated with a combination of corticosteroid and antifibrotic agents.
Subjects
corticosteroid; e‐cigarette or vaping product use associated lung injury (EVALI); organizing pneumonia; pirfenidone
corticosteroid; e-cigarette or vaping product use associated lung injury (EVALI); organizing pneumonia; pirfenidone
SDGs
Other Subjects
antifibrotic agent; azathioprine; corticosteroid; cyclophosphamide; methylprednisolone; mycophenolic acid; pirfenidone; prednisolone; adult; Article; blood pressure; breathing rate; case report; clinical article; computer assisted tomography; corticosteroid therapy; coughing; crackle; diffusing capacity for carbon monoxide; dyspnea; exertional dyspnea; forced expiratory volume; forced vital capacity; high resolution computer tomography; human; leukocyte count; low drug dose; lung biopsy; lung function test; male; middle aged; oxygen saturation; physical examination; vaping associated lung injury