Probable basis: use of a substance not approved by the manufacturer, either as a flavoring or with substance abuse. More than one substance may be involved. Cannabidiol (CBD) oil has been implicated in some cases.
Source of substance: by user, from "street" source
Clinical presentation: worsening dyspnea, nausea, vomiting, fever and abdominal discomfort
Laboratory findings: leukocytosis with neutrophilia and absence of eosinophilia
CDC criteria - general:
(1) using an electronic cigarette within 90 days of clinical onset
(2) pulmonary infiltrate (opacities in chest X-ray, ground-glass opacities on chest CT)
(3) no other diagnosis that can explain the findings better
Additional CDC criteria for confirmed diagnosis:
(1) absence of pulmonary infection on initial work-up
Additional CDC criteria for probable diagnosis - one or both of the following:
(1) infection identified on work-up but pathogen cannot explain the underlying respiratory disease
(2) minimum testing to rule-out an infectious agent is incomplete
Minimum infectious disease testing:
(1) respiratory viral panel
(2) influenza
(3) Streptococcus pneumoniae
(4) Legionella species
(5) respiratory tract culture
(6) opportunistic organisms if HIV-positive or immunosuppressed
Lung biopsy may show a lipoid pneumonia, suggesting the addition of an oil to the vaping solution.
