Based on the available case investigations, 95% of patients with EVALI initially experienced respiratory symptoms including cough, chest pain, and shortness of breath, while 77% also experienced gastrointestinal symptoms including abdominal pain, nausea, vomiting, and diarrhea. Up to 85% of patients had concomitant systemic symptoms such as fever, chills, and weight loss.
On examination, 55% of patients were noted to be tachycardic, 45% were noted to be tachypneic, and 57% had saturations on room air of less than 95%. By and large, pulmonary findings on auscultation were unremarkable, even among those with severe lung injury.
Laboratory findings were also fairly nonspecific, with 87% of patients having a WBC > 11 000 and 93% with elevated ESR > 30 mm/hr. Half of patients (50%) had elevated liver transaminases (aspartate transaminase / alanine transaminase [AST / ALT] > 35 U/L).
Radiographic findings of EVALI included infiltrates on chest x-ray and opacities on chest CT but were nonspecific. Up to 91% of patients had an abnormal chest x-ray in one study, and 100% had abnormal chest CTs, classically with ground glass opacities of both lungs.
EVALI remains a diagnosis of exclusion, as no specific test or marker exists for diagnosis.
Patients should be evaluated for alternative etiologies including viral respiratory tract infections (eg, influenza) and common etiologies of community-acquired pneumonia (eg, Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila).
Hypoxic patients and those in respiratory distress warrant hospitalization, and patients with even mild symptoms can deteriorate rapidly over 48 hours. Some patients, particularly those older than 50 years, may progress to respiratory failure, necessitating endotracheal intubation and mechanical ventilation.
Patients with EVALI and a history of asthma or other respiratory disease, cardiac disease, a mental health condition, or obesity may be at increased risk of death.
Related topics: cannabis use disorder, synthetic cannabinoid poisoning, nicotine dependence
J68.0 – Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors
J69.1 – Pneumonitis due to inhalation of oils and essences
315345002 – Acute lung injury
- Viral LRTIs
- Bacterial LRTIs (eg, Streptococcus pneumoniae pneumonia), including atypical etiologies (eg, Mycoplasma)
- Endemic mycoses (blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, penicilliosis, and sporotrichosis)
- Opportunistic infections in the setting of immunocompromise (eg, Pneumocystis jirovecii pneumonia in patients with human immunodeficiency virus [HIV])
- Pulmonary edema
- Aspiration pneumonitis (see aspiration pneumonia)
- Acute respiratory distress syndrome (ARDS)