Challenges in Diagnosing Vaping-Associated Acute Lung Injury During the COVID-19 Pandemic

We encountered a 34-year-old man with a significant vaping history who presented with acute hypoxic respiratory failure, headaches and gastrointestinal symptoms during the COVID-19 pandemic. Based on his laboratory and chest CT findings, we had a high clinical suspicion for COVID-19 and EVALI, yet distinguishing the diagnoses proved challenging. His SARS-CoV-2 nasopharyngeal PCR swabs were negative. However, this test has a low sensitivity. COVID-19 serology testing was negative, and the patient was ultimately diagnosed with EVALI based on subtle chest CT findings. To our knowledge, this is the first paper highlighting the similarities and distinguishing features of EVALI and COVID-19 acute lung injury.