A woman, originally suspected of having covid-19, turned out to have a lung injury linked to the use of tainted vaping devices, according to a case report in BMJ Case Reports.

According to the report, the woman first visited doctors in late 2020 after experiencing a week of ongoing cough, fatigue, shortness of breath, and recurrent fever, as well as abdominal pain, nausea and vomiting, and headaches. Testing soon showed she had low levels of blood oxygen, impaired respiratory function, and likely lung inflammation, prompting hospitalization. Despite testing negative for the coronavirus on two PCR tests (used to confirm acute infection), the ongoing pandemic led doctors to initially treat her as a covid-19 case, since tests can sometimes be inaccurate. She was given oxygen, the steroid dexamethasone—a common treatment for hospitalized covid-19 cases—and antibiotics in case of a bacterial infection. By day 2, her condition had improved enough for her to be discharged.

But 11 weeks later, her symptoms had returned and some had even worsened, leading to a second hospital admission. By that time, an antibody test for the coronavirus, taken during her first discharge, had also come back negative, and doctors began to strongly suspect something else had to explain what was happening.

Though the woman reported a history of vaping at the start of her first visit, further questioning this time revealed that she had been vaping up to five days a week recently and had resumed vaping between hospitalizations. Based on her test results and the lack of evidence of covid-19 or any other infectious cause of pneumonia, the doctors finally diagnosed her with EVALI, which is short for E-cigarette or vaping product use-associated lung injury.

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