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E-cigarette or vaping product use associated lung injury in the time of COVID-19: A clinical dilemma
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  • Daniel Helfgott,
  • Gabrielle Capozzoli,
  • Jovanna Madray,
  • Lakshmi Uppaluri,
  • Aisha Baig,
  • Sunanda Gaur,
  • Mitchell Simon,
  • Judith Amorosa,
  • MAYA RAMAGOPAL
Daniel Helfgott
Rutgers Robert Wood Johnson Medical School New Brunswick
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Gabrielle Capozzoli
Rutgers Robert Wood Johnson Medical School New Brunswick
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Jovanna Madray
Rutgers Robert Wood Johnson Medical School New Brunswick
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Lakshmi Uppaluri
Rutgers Robert Wood Johnson Medical School New Brunswick
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Aisha Baig
Rutgers Robert Wood Johnson Medical School New Brunswick
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Sunanda Gaur
Rutgers Robert Wood Johnson Medical School New Brunswick
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Mitchell Simon
Rutgers Robert Wood Johnson Medical School New Brunswick
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Judith Amorosa
Rutgers Robert Wood Johnson Medical School New Brunswick
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MAYA RAMAGOPAL
Rutgers Robert Wood Johnson Medical School New Brunswick
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Abstract

AIM: To report on the clinical, laboratory and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of COVID-19, did not test positive for the infection and were diagnosed with e-cigarette and vaping product use associated lung injury (EVALI). Methods: A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted. Results: The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a past history of anxiety, depression or other psychiatric/mental health disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and eleven had elevated inflammatory markers. Eleven needed respiratory support. 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. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine THC was positive in all cases. CXR and CT findings showed ground glass opacities. CONCLUSIONS: Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with ‘typical’ COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.

Peer review status:IN REVISION

30 Jul 2020Submitted to Pediatric Pulmonology
31 Jul 2020Assigned to Editor
31 Jul 2020Submission Checks Completed
01 Aug 2020Reviewer(s) Assigned
23 Sep 2020Review(s) Completed, Editorial Evaluation Pending
24 Sep 2020Editorial Decision: Revise Major