Citation

Marsden L, Michalicek ZD, Christensen ED. New Engl. J. Med. 2019; ePub(ePub): ePub.

Affiliation

Office of the Medical Examiner, Taylorsville, UT edchristensen@utah.gov.

Copyright

(Copyright © 2019, Massachusetts Medical Society)

DOI

10.1056/NEJMc1914980

PMID

31747506

Abstract

Despite increased numbers of cases of vaping-associated lung injury,1,2 descriptions of the pathology underlying the condition have been limited to findings in surgical lung biopsies from hospitalized patients, as in the reports by Butt et al. (Oct. 31 issue) and others.3,4 We performed an autopsy on a young man who had a history of a respiratory illness with cough, sore throat, and fever. After 5 days of the illness, he had been seen by a physician and received a prescription for a course of azithromycin, which he completed. He was subsequently found deceased in his residence. Tetrahydrocannabinol (THC) e-cigarette cartridges were present.

The autopsy revealed heavy lungs (combined weight, 3060 g). Changes characteristic of acute lung injury, including diffuse alveolar damage, were present. Macrophages containing lipid and granular brown–black refractile foreign material were present in alveoli. Scant neutrophils and eosinophils were present. There was marked type 2 pneumocyte hyperplasia with prominent nucleoli and multinucleation (Figure 1), as well as scattered mitotic figures (some atypical). Special stains for infectious organisms were negative, as was follow-up testing for infectious disease at the Centers for Disease Control and Prevention (CDC). Toxicologic testing revealed marijuana constituents.
This description of untreated vaping-associated lung injury examined at autopsy provides a look at the pathology of the process independent of medical intervention ...

Language: en