Concurrent e-cigarette or vaping product use-associated lung injury (EVALI) and myopericarditis: a rare case report and literature review

With the rise in vaping both in Vietnam and globally, acute complications related to vaping are becoming increasingly recognized. Although lung injury is the most common clinical presentation, instances of cardiac damage, including pericardial involvement, albeit less frequently, have also been reported. We describe what is, to our knowledge, the first reported instance of an adolescent who developed acute respiratory distress syndrome and myopericarditis in temporal association with vaping. A previously healthy 17-year-old male resumed heavy e-cigarette use three days before experiencing sudden pleuritic chest pain and dyspnoea. On admission, he rapidly progressed to hypoxaemic respiratory failure requiring mechanical ventilation and vasopressor support. Chest X-ray bilateral opacities, consistent with EVALI. Transthoracic echocardiography revealed a circumferential pericardial effusion (up to 14 mm) without ventricular dysfunction. Cardiac biomarkers were markedly elevated. Diagnosed with e-cigarette, or vaping-associated lung injury (EVALI) and myopericarditis, lung-protective ventilation, intravenous methylprednisolone and empiric broad-spectrum antibiotics were instituted. The patient responded well to the corticosteroid treatment. Follow-up imaging confirmed near-complete resolution of pulmonary infiltrates and complete resolution of the pericardial effusion. He has remained asymptomatic at three-month review after counselling to cease vaping. A review of the literature on acute cardiac complications associated with e-cigarettes suggests that these complications may be underrecognized. This case highlights that vaping-related injury can extend beyond the lungs, eliciting simultaneous fulminant pulmonary and cardiac inflammation. Clinicians should maintain a high index of suspicion for EVALI and associated extrapulmonary issues like myopericarditis in young patients presenting with acute cardiorespiratory failure following e-cigarette use and should obtain a detailed vaping history to guide timely diagnosis and corticosteroid therapy.