Cardiogenic Shock Due to Reversed Takotsubo Syndrome Associated with E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI): A Case Report

Abstract

As the use of electronic cigarettes increases and the incidence of electronic cigarette or vaping product-associated lung injury (EVALI) grows, knowledge of its associated conditions is essential to emergency and critical care physicians. A 30-year-old female patient was admitted to a private tertiary hospital in South Brazil with nonspecific gastrointestinal and respiratory symptoms. Within 24 h, rapid worsening was observed that necessitated endotracheal intubation and mechanical ventilation, as well as multiple vasoactive drugs administration for hemodynamic instability with evidence of severe left ventricular dysfunction. Infectious, thromboembolic, and rheumatological diseases were excluded. Patient had used electronic cigarettes 48 h prior to start of symptoms. Pulmonary imaging showed bilateral ground-glass opacities predominantly on the upper and middle lobes. Consistent with EVALI diagnosis, corticosteroids and broad-spectrum antibiotics were started. Patient showed remarkable improvement over the following hours. Cardiac magnetic resonance was compatible with reversed Takotsubo syndrome, and subsequent echocardiograms demonstrated significant improvement. The patient was extubated 48 h after admission and was discharged on the sixth day. EVALI must be considered a possible cause of acute respiratory failure in low-income countries and may trigger reversed Takotsubo syndrome. As two easily overlooked diagnoses, physicians must remain vigilant for these possibilities.