Vaping induced platelet dysfunction

Abstract

Case Report: A 28-year-old lady with no significant medical history was admitted to the hospital with shortness of breath. Patient was 36 weeks pregnant and was recently admitted to another facility with the diagnosis of community acquired pneumonia. On admission, patient was hypoxemic with oxygen saturation between 80 and 86% on room air. Chest x-ray showed extensive multifocal bilateral consolidative opacities. She was also found to be tachycardic with a heart rate between 110 and 120 beats/minute. She was started on broad spectrum antibiotics and pulmonology were later consulted. Patient's condition continued to worsen and she had to have an emergency cesarean section. Following her delivery, she started to have hemoptysis and underwent bronchoscopy that revealed diffuse alveolar hemorrhage (DAH). She was started on steroids and autoimmune workup was sent which all came back negative. Her prothrombin time, partial thromboplastin time, international normalized ratio, d-dimer and fibrinogen were also within normal limits. Later, shewas noted to have hematuria. Hematology were then consulted and they did a thorough evaluation. They also reviewed her social history with her husband who acknowledged us on the fact that the patient vapes regularly. The conclusion was then made that the patient was having vaping induced platelet dysfunction and she was advised to quit vaping. Discussion: There has been very limited published literature on the adverse effects of electronic cigarettes despite their introduction in 2007. The use of vaping has overtaken the standard electronic cigarettes in our current time and it has been a challenge to understand the health risks that they have due to the rapidly changing designs and lack of long-term follow-up. The few published reports are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis. DAH is an entity associated with injury to arterioles, venules, or alveolar capillaries. It can be further divided into three types including pulmonary capillaritis, bland alveolar hemorrhage, and diffuse alveolar damage. Its etiology originates from either a localized injury to the lung by means of inhalation injuries or through a systemic disorder such as vasculitis or connective tissue disease. There has been a case published by Agustin M. et al in 2018 about vaping induced DAH where they hypothesized a mechanism. Yet, it continues to be an area that lacks a lot of research. Given that our patient had a negative autoimmune workup, normal platelets, and a normal coagulation profile we are hypothesizing a direct correlation between platelet dysfunction and vaping. Although our patient may have had a direct inhalational injury from vaping that led to her DAH, it does not completely explain why she was also having hematuria. There were no complications during her cesarean section nor did the patient have abdominal or uterine bleeding that would suggest otherwise.