Disclosures: Sterling Haring, DO, MPH: Nothing to disclose

Case Description: The day of presentation (Day 0), the patient was offered an ice cream flavored e-cigarette. She denies having used an e-cigarette or any similar device in at least 3 years prior. She and her friends took turns using the device over the ensuing several minutes. Within 1-2 hours, she developed dyspnea and a headache and subsequent circumoral cyanosis. CXR at a local hospital demonstrated pulmonary edema with ground glass appearance. She was noted to have 26.7 WBCs (92% PMNs). Urine drug screen was negative. ECG showed sinus tachycardia and echocardiogram was normal. She developed worsening dyspnea and cough, eventually requiring intubation and pressors. Antibiotics were started and broadened, and she was transferred to a large academic pediatric hospital for ARDS.

Setting: Quaternary academic pediatric medical center.

Patient: A previously-healthy 17-year old girl with a history of scoliosis and occasional tobacco use.

Assessment/Results: Repeat viral PCR was negative, and initial CBC revealed 47 WBCs and eosinophilia. Pediatric ID was consulted, and antibiotics were again broadened. Thorough infectious workup was negative. On day 7 of hospitalization, she was started on ECMO and underwent bronchoalveolar lavage, which revealed marked eosinophilia. Based on these findings, she was diagnosed with hypersensitivity pneumonitis, believed to be secondary to e-cigarette use a few hours before symptom onset. With treatment, she gradually recovered cardiopulmonary function. PM&R was consulted for symptom management and early intervention. As she regained strength, unilateral neuromuscular deficits became increasingly apparent; MRI revealed an ischemic watershed stroke due to poor cerebral perfusion during shock.

Discussion: After a single episode of vaping, an otherwise healthy 17-year-old girl developed hypersensitivity pneumonitis with ARDS and cardiopulmonary collapse, culminating in stroke.

Conclusion: While much of the concern about vaping is related to its contribution to tobacco use, direct risks should also be considered.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cardiopulmonary-collapse-resulting-in-stroke-after-a-single-episode-of-vaping-a-case-report/