CONCLUSION
We report the first-ever case of Midwakh associated Acute Lung Injury
(MALI), which posed a diagnostic challenge during the COVID-19 pandemic
period. It was a diagnosis of exclusion and was based on a history of
clinical presentation, signs and symptoms, radiological features. It was
a close mimic of the recent EVALI epidemic in the USA. Our case
responded to a high dose of Steroids, Prone ventilation with ultra-short
lung-protective settings. Significant recovery was achieved at three
months though the long-term effects have to be watched for.
As of 2020, there are no such clinical studies on Midwakh to identify
long term risks attributable to it. We recommend additional research and
studies to identify the pathophysiology of acute lung injury, acute and
long-term effects of Midwakh smoking. We request physicians and
pediatricians to work closely with adolescents and their parents to
discourage tobacco products. Appropriate public health education and
strictly obeying the country’s tobacco control laws can prevent a MALI
epidemic in the region and protect the younger generation.