Vaping-Related Respiratory Illness Characterized by Fat-Laden Cells in the Lungs

Researchers from University of Utah (U of U) Health have characterized the nascent respiratory illness associated with e-cigarette vaping by the presence of fat-laden cells, which they identified with the use of oil red O staining tests. The findings, which may enable physicians to accurately diagnose the syndrome, were published in The New England Journal of Medicine.

As of last week, officials have reported 450 cases in the US of this mysterious illness spread across 33 states and one territory, with the first reported death occurring on Aug. 23 in Illinois. According to the Centers for Disease Control (CDC), patients have typically experienced respiratory problems such as coughing, chest pain, shortness of breath, nausea, vomiting, diarrhea, and fatigue. While researchers are still looking to pinpoint the exact cause of the illness, they have postulated that the ingredients found in e-cigarettes may play a factor.

The U of U Health researchers discerned the lipid-laden macrophages in the lungs of six out of six cases observed at the University of Utah Hospital, including that of a previously healthy 21-year-old man who had been vaping nicotine and tetrahydrocannabinol (THC). The patient initially presented with dyspnea, cough, abdominal pain, and vomiting. He was subsequently treated for bacterial pneumonia, but after his condition deteriorated, he was intubated for acute respiratory distress syndrome. Laboratory testing revealed notably elevated level of C-reactive protein, and bronchoalveolar lavage (BAL) fluid revealed more than 50% lipid-laden macrophages.

A Potential Diagnostic Marker

“While it is too soon to be sure, these lipid-laden macrophages may turn out to be useful to confirm or rule out this disease,” said the study’s senior author Scott Aberegg, M.D., a critical care pulmonologist at U of U Health in a press release about the findings. “They may also be helpful in understanding what is causing this illness.”

BREAKING – Mysterious Vaping Illness Characterized by Fat-laden Cells in the Lung via @UofUHealth @UUtah in @NEJM – The finding could allow doctors to definitively diagnose the nascent syndrome and provide clues into causes of the mysterious condition https://t.co/Pj6LPJMgPm

— Julie Kiefer (@JulieCKiefer) September 6, 2019

“These cells are very distinctive, and we don’t often see them. That made everybody start to think carefully about why they were there. Are they scavenging debris in the lungs that was introduced through vaping?” Dr. Aberegg continued.

The researchers noted that additional testing is required to determine whether this vaping illness can be characterized as a new form of lipid pneumonia, because it presents differently from classic lipid pneumonia. According to Dr. Aberegg: “We need to determine if these cells are specific for the illness or whether they are also seen in vaping patients who are not ill and don’t have symptoms. If they are only seen in patients who get sick, we can begin to make some connections between what we’re seeing in the lipid laden macrophages and whatever components of the vaping oils may be causing this syndrome.”

Mysterious vaping #illness characterized by fat-laden #cells in the lung @nejm https://t.co/39prGiJEk1

— Medical Xpress (@medical_xpress) September 6, 2019

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