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SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: This is a case of a young female presenting with cough, fevers, and shortness of breath during peak COVID-19 infection in her community CASE PRESENTATION: A 19-year-old female presented to the ED due to concerns for Covid-19 infection with several days of fever, cough, pleuritic chest pain, and shortness of breath She was found to be hypoxic to 85% on room air with significant tachypnea and tachycardia Initial labs notable for leukocytosis and elevated D-dimer CT chest was negative for pulmonary embolism but did show diffuse bilateral patchy opacities and bilateral hilar lymphadenopathy She was tested for Covid-19 with nasopharyngeal swab PCR and was negative Respiratory viral panel and sputum cultures were negative Upon further history taking, the patient admits to the use of marijuana and tobacco by vaping She was treated with IV methylprednisolone and azithromycin with resolution of her symptoms and hypoxia DISCUSSION: E-cigarettes have increasingly gained popularity, especially among younger patients A large number of EVALI cases appear to be related to the use of marijuana or THC-containing vaping oils This patient’s symptoms of fevers, cough, and shortness of breath are common in both EVALI and Covid-19 She presented to the hospital during peak Covid-19 cases in the community however she tested negative for the virus After infectious and viral causes were excluded she was diagnosed with EVALI She had significant improvement with azithromycin and steroids CONCLUSIONS: EVALI and Covid-19 can present with similar symptoms of fever, cough, and shortness of breath Both diseases may present with bilateral patchy opacities on imaging EVALI and Covid-19 infection should both be considered in patients who present with respiratory symptoms with history of vaping use Reference #1: Bernheim A, Mei X, Huang M, et al Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection Radiology 2020;295(3):200463 doi:10 1148/radiol 2020200463 Reference #2: Kalininskiy A, Bach CT, Nacca NE, et al E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach The Lancet Respiratory Medicine 2019;7(12):1017-1026 doi:10 1016/s2213-2600(19)30415-1 DISCLOSURES: No relevant relationships by Niloufar Gharib, source=Web Response
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