Samenvatting
Introduction:
Since the outbreak of vaping-associated lung injury (VALI) in 2019, the CDC has established a clear link between VALI and the use of tetrahydrocannabinol (THC)-containing products, as 82% of patients hospitalized for VALI endorsed the use of THC-containing products.
It is commonly understood that aspergillus along with various other yeasts and molds frequently colonize cannabis plants as well as unregulated THC-containing products, including vaping liquids and cartridges.
Invasive aspergillosis has formerly been associated with cannabis use in the immunocompromised host, additionally in immunocompetent patients with COPD and, more recently, in immunocompetent e-cigarette smokers.
Case:
We report the case of a 27-year-old man who presented to the emergency department of a tertiary hospital in Brussels, Belgium, with complaints of acute respiratory distress and a cough worsening over the past 72 hours. Despite the patient's lack of medical history or long-term treatment, the patient initiated vaping and consumed cannabis during the month preceding his hospitalization. A diagnosis of community-acquired pneumonia was suspected, for which cefuroxime IV. was initiated at admission.
However, as the patient's condition continued to worsen on the fifth day of antimicrobial treatment, while microbiological examinations remained negative, a thoracic CT scan was performed. The latter revealed bilateral nodular infiltrates with the presence of the inverted halo sign, as well as a right pleural effusion, raising the suspicion of a mycobacterial, fungal or bacterial infection, possibly complicated by an empyema. Although culture of pleural- and bronchoalveolar lavage fluid remained negative, investigations revealed a positive galactomannan. Treatment with voriconazole was subsequently initiated on suspicion of invasive pulmonary aspergillosis.
In the following days, we observed a favorable clinical, radiological and biological evolution under this treatment. Amoxicillin-clavulanic acid PO was nevertheless continued, as bacterial pneumonia with empyema could not be ruled out since microbiological cultures had been carried out under antibiotic treatment.
Conclusion:
We report a case of VALI complicated by invasive aspergillosis in a patient with a history of cannabis use and vaping. Invasive pulmonary aspergillosis can be viewed as part of the differential diagnosis of necrotizing pneumonia in (immunocompetent) patients using e-cigarettes in association with cannabis.
Since the outbreak of vaping-associated lung injury (VALI) in 2019, the CDC has established a clear link between VALI and the use of tetrahydrocannabinol (THC)-containing products, as 82% of patients hospitalized for VALI endorsed the use of THC-containing products.
It is commonly understood that aspergillus along with various other yeasts and molds frequently colonize cannabis plants as well as unregulated THC-containing products, including vaping liquids and cartridges.
Invasive aspergillosis has formerly been associated with cannabis use in the immunocompromised host, additionally in immunocompetent patients with COPD and, more recently, in immunocompetent e-cigarette smokers.
Case:
We report the case of a 27-year-old man who presented to the emergency department of a tertiary hospital in Brussels, Belgium, with complaints of acute respiratory distress and a cough worsening over the past 72 hours. Despite the patient's lack of medical history or long-term treatment, the patient initiated vaping and consumed cannabis during the month preceding his hospitalization. A diagnosis of community-acquired pneumonia was suspected, for which cefuroxime IV. was initiated at admission.
However, as the patient's condition continued to worsen on the fifth day of antimicrobial treatment, while microbiological examinations remained negative, a thoracic CT scan was performed. The latter revealed bilateral nodular infiltrates with the presence of the inverted halo sign, as well as a right pleural effusion, raising the suspicion of a mycobacterial, fungal or bacterial infection, possibly complicated by an empyema. Although culture of pleural- and bronchoalveolar lavage fluid remained negative, investigations revealed a positive galactomannan. Treatment with voriconazole was subsequently initiated on suspicion of invasive pulmonary aspergillosis.
In the following days, we observed a favorable clinical, radiological and biological evolution under this treatment. Amoxicillin-clavulanic acid PO was nevertheless continued, as bacterial pneumonia with empyema could not be ruled out since microbiological cultures had been carried out under antibiotic treatment.
Conclusion:
We report a case of VALI complicated by invasive aspergillosis in a patient with a history of cannabis use and vaping. Invasive pulmonary aspergillosis can be viewed as part of the differential diagnosis of necrotizing pneumonia in (immunocompetent) patients using e-cigarettes in association with cannabis.
| Originele taal-2 | English |
|---|---|
| Status | Published - 1 dec 2023 |
| Evenement | Annual congress of the Belgian Society of Internal Medicine - La Hulpe, Belgium Duur: 1 dec 2023 → 2 dec 2023 https://bsim.wildapricot.org/ |
Conference
| Conference | Annual congress of the Belgian Society of Internal Medicine |
|---|---|
| Land/Regio | Belgium |
| Periode | 1/12/23 → 2/12/23 |
| Internet adres |