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Midwakh associated Acute Lung Injury (MALI): An emerging epidemic in the Middle East -A Case Report and review of literature
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  • Angel Varughese,
  • Suneel Pooboni,
  • Vijay Vinod,
  • Rania Abusamra
Angel Varughese
Mediclinic City Hospital

Corresponding Author:[email protected]

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Suneel Pooboni
Mediclinic Middle East
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Vijay Vinod
Mediclinic City Hospital
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Rania Abusamra
Mohammed Bin Rashid University of Medicine and Health Sciences Hamdan Bin Mohammed College of Dental Medicine
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Tobacco in any form is harmful. There is an alarming increase consumption of Alternative Tobacco Products (ATPs). Midwakh is one of the most used ATP in UAE, particularly amongst adolescents. In addition to harmful levels of cobalt, chromium, cadmium, Iron and lead, Midwakh has higher nicotine and tar content when compared to shisha and cigarettes. We report a 14-year-old adolescent male, who presented with Acute Lung Injury within 24 hours following a first attempt of Midwakh smoking, a presentation remarkably similar to E-Cigarettes or Vaping Associated Lung Injury. A high-resolution computerized tomogram of the chest (HRCT) showed bilateral interstitial pneumonia with ground glass appearance and patchy consolidation. A flexible bronchoscopy revealed bilateral petechial hemorrhages with erythematous bronchial walls. Mechanical ventilation was required for two weeks with high ventilatory settings due to poor lung compliance. The criteria for moderately severe ARDS was met, and a good response was achieved to a high dose of steroids, prone ventilation with ultra-short lung protective strategy. Initial spirometry tests done post extubation were compatible with severe restrictive lung disease. Significant clinical and radiological recovery was achieved at three months. To our knowledge and as per the literature reviewed, this is the first case of Midwakh associated acute lung injury reported till date. We wish to emphasize that physicians should be well informed about the use of ATPs, both existing and emerging ones and its potential severe complications.