INTRODUCTION
Tobacco is one of the leading causes of death in the world3. The prevalence of adolescent smoking is alarming, with around 24 million children (13-15 years) worldwide, of which 13 million of them use smokeless tobacco products3.Exposure of nicotine during adolescence or childhood has deleterious effects on brain development, as smoking leads to impaired lung function and growth. As per the WHO Global Youth and Adult Tobacco Survey, there is an alarming increase and a growing concern of Alternative Tobacco Products (ATPs)3,4,5.Common ATPs range from Electronic Cigarettes, Hookah or Shisha, Midwakh or Dokha, and various Smokeless Tobacco products. Midwakh and Dokha are two terms that are often used interchangeably.
Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) cause significant morbidity and mortality among the affected, particularly the younger generation. Smoking exposes the lungs to severe detrimental effects on epithelial and endothelial function, quite similar to ALI.
In 2020, over 2800 E-Cigarettes or Vaping Associated Lung Injury (EVALI)cases of hospitalization or deaths have been reported to the Centre for Disease Control (CDC|) from all 50 states in the USA, with ages ranging from 13-85 years6.
We report a 14-year-old adolescent male, who presented with signs and symptoms of ALI / ARDS following a single session of Midwakh smoking, a presentation very similar to EVALI. To our knowledge, this is the first case of Midwakh Associated Acute Lung Injury (MALI) ever reported to date.