AIM: To report on the clinical, laboratory and radiological findings of adolescents who presented during the SARS-CoV-2 surge with symptoms of COVID-19, did not test positive for the infection and were diagnosed with e-cigarette and vaping product use associated lung injury (EVALI). Methods: A retrospective review of 12 cases of EVALI admitted to the Bristol Meyers Squibb Children’s Hospital between February 2020 and June 2020 was conducted. Results: The ages of the patients ranged from 14 to 19 years. There were 6 males and 6 females. Three patients had a past history of anxiety, depression or other psychiatric/mental health disorder, nine had prolonged coagulation profile (PT,PTT and/or INR) and eleven had elevated inflammatory markers. Eleven needed respiratory support. All 12 were negative for SARS-CoV-2 PCR. Four were tested for IgG Antibodies and were negative. As these cases were admitted to rule out COVID infection, initial treatment included hydroxychloroquine. Steroids were started only after SARS-CoV-2 PCR was shown to be negative. Urine THC was positive in all cases. CXR and CT findings showed ground glass opacities. CONCLUSIONS: Clinical and radiological features are similar in both EVALI and SARS-CoV-2 infection. Inflammatory markers are elevated in both conditions. A detailed social and substance use history in patients presenting with ‘typical’ COVID pneumonia like illness is important. EVALI should be ruled in early to start the appropriate treatment. Given the ongoing pandemic, pediatricians and other health care providers need to be aware of other conditions that can masquerade as SARS-CoV-2.
Sleep-disordered breathing is an underrecognized comorbidity in the cystic fibrosis (CF) population across the lifespan. Nocturnal hypoxia, obstructive sleep apnea (OSA), and nocturnal hypoventilation are respiratory abnormalities that occur commonly during sleep, and have deleterious consequences to quality of life in people with CF. Effective screening for these abnormalities is needed to allow for the timely initiation of treatment. Lack of treatment leads to worse pulmonary, cardiovascular, and metabolic outcomes in patients. In this review, we give an overview of sleep-disordered breathing for the CF clinician, including definitions, treatment, and suggestions for future research. We strongly encourage the CF community to incorporate evaluation for sleep-disordered breathing, so that outcomes for the subset of the patients with coexisting sleep-disordered breathing improve.