Discordant bilateral bronchoalveolar lavage findings in a patient with acute eosinophilic pneumonia associated with counterfeit tetrahydrocannabinol oil vaping

Daniel Puebla Neira, MD; Sarah Tambra, MD; Vibha Bhasin, MD; Ranjana Nawgiri, MD; Alexander G. Duarte, MD

Respiratory Medicine Case Reports (Jan 2020)

Discordant bilateral bronchoalveolar lavage findings in a patient with acute eosinophilic pneumonia associated with counterfeit tetrahydrocannabinol oil vaping

Daniel Puebla Neira, MD,
Sarah Tambra, MD,
Vibha Bhasin, MD,
Ranjana Nawgiri, MD,
Alexander G. Duarte, MD

Affiliations

Daniel Puebla Neira, MD: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, USA; Corresponding author. Division of Pulmonary, Critical Care and Sleep Medicine. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Sarah Tambra, MD: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
Vibha Bhasin, MD: Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
Ranjana Nawgiri, MD: Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
Alexander G. Duarte, MD: Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; Division of Pulmonary and Critical Care Medicine, University of Texas Medical Branch, Galveston, TX, USA

Journal volume & issue: Vol. 29

Abstract

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Vaping has emerged as a popular alternative form of inhalation of nicotine and marihuana derivates (including Tetrahydrocannabinol, THC) in part due to the avoidance of combustion byproducts. Unfortunately, THC oil (especially that produced by unregulated individuals) may contain dilutants such as propylene glycol, vitamin E, and flavoring ingredients that can lead to adverse respiratory effects. Acute eosinophilic pneumonia (AEP) has been described in association with e-cigarette and vaping associated lung injury (EVALI) but the majority of bronchoalveolar lavage (BAL) samples reported in the literature do not show eosinophils as the predominant cell lineage. Only two other cases of AEP have been published, and here we present the first case reported in the literature of a patient with EVALI with AEP pattern associated with counterfeit tetrahydrocannabinol (THC) oil vaping and discordant bilateral BAL cell count differential.

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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