A teenage vaper on the verge of death had to be put on a ventilator after e-cigarettess caused her lungs to become inflamed and splotchy, indicating damage,. 

The 19-year-old went to the emergency department with abnormally high , difficulty breathing, a fever, and an insufficient amount of oxygen in her blood.

She was initially diagnosed with severe bacterial pneumonia, which they treated with antibiotics. 

But when antibiotics did nothing to improve her condition, doctors were perplexed.

Scans showed transluscent spots all over her lungs, suggesting the lungs were full of fluid and signs of tissue damage. 

They eventually asked her if she was an e-cigarette user and, after ruling out Covid and bacterial pneumonia, diagnosed her with E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI).

EVALI has been a concern for years as the rate of youth vape use has skyrocketed.

Public health reports show that around 2,800 patients were hospitalized due to EVALI in 2020, 15 percent of whom were teens, signaling the start of a small epidemic of EVALI cases across the US.

The young woman suffered symptoms for a week before going to the hospital, including high-grade fever with chills, cough, and shortness of breath at rest.

Before going to the hospital, she had been prescribed azithromycin, an antibiotic, for five days. 

She didn’t undergo any CT or MRI scans, so doctors could not see the glass opacities, or hazy spots in her lungs, basing their decision to prescribe the medicine on her symptoms, which mirrored those of a bacterial infection.

Glass opacities often occurs alongside consolidation in the lungs. Consolidation refers to the thickening or swelling of lung tissue, which happens when the air spaces in the lungs fill with fluid, pus, blood, or cells. 

The morning she decided to go to the hospital, her breathing troubles had reached their peak.

When she arrived, her heart rate was higher than usual at 120 beats per minute, and her respiratory rate was elevated at 26 breaths per minute, higher than the normal range (60-100 bpm). The standard respiratory rate is about 12 to 20 breaths per minute.

She had a fever, and doctors discovered that she was hypoxemic, meaning her blood was not carrying enough oxygen. 

Doctors hooked her up to a ventilator, administered more antibiotics and gave her medicine to manage her fever.

However, when they saw no improvement after 48 hours, they ruled out bacterial pneumonia and Covid. 

A pulmonologist was brought in, given the baffling nature of her case, and finally asked her about whether she used e-cigarettes.

The patient reported vaping e-cigarettes over the last month daily. They diagnosed her with lung damage caused by EVALI.

EVALI is a respiratory illness that mimics other infections and is caused by inhalation of toxic substances added to vaping liquid that induces a chemical type of pneumonia.

EVALI is a diagnosis of exclusion because no clear criteria for it exist.

Imaging findings typically show hazy spots on the lungs.

Treatment consists of steroids along with supportive care with oxygen and complete cessation of E-vaping. 

Patients typically respond well to steroid treatment, and the prognosis is generally good after diagnosis.

According to a CDC investigation of an EVALI outbreak in 2019, vitamin E acetate could be the cause. This compound has been detected in product samples tested by FDA and state laboratories, as well as in lung fluid samples from EVALI patients tested by the CDC across various states.

Notably, Vitamin E acetate has not been found in the lung fluid of individuals without EVALI.

Doctors gave the patient a high dose of a steroid called prednisone. Her breathing symptoms improved, and the indicators of lung inflammation decrSased. Her blood oxygen levels also improved and she could leave the hospital. 

She would recover well as long as she stayed away from vapes, 

Doctors warned her not to start vaping again, saying the risk of EVALI striking again would be very high.

First introduced in the US around 2007, e-cigarettes are now the most used tobacco product among youth in the US, often marketed as a safer alternative to regular cigarettes.

Among middle and high school students, 2.8 million (10 percent) reported current use of a tobacco product such as a vape in 2023. Additionally, 2.13 million (7.7 percent) students reported current e-cigarette use in 2023.