A 15‐year‐old female with a past medical history of anxiety, depression, and attention deficit hyperactivity disorder (ADHD) presented to her primary care physician with a history of 4 days of nausea, vomiting, diarrhea, and mild intermittent dry cough. Upon inquiry, the patient reported vaping for the past 6 months, two to three times per week, about five “hits” during each vape session. However, she denied vaping for 1 week before the onset of symptoms. She reported using both open and closed system devices. She reported vaping nicotine pods and using an open system device to vape a THC‐containing product. Her vital signs were significant for heart rate (HR) of 116, respiratory rate (RR) of 34, oxygen saturation (SpO₂) of 78%, and temperature of 100.5 Fahrenheit (F). She was admitted to the pediatric nursing unit on 3 L of supplemental oxygen via nasal cannula (NC). Initial chest X‐ray (CXR) showed findings of bilateral interstitial reticular opacities with trace bilateral pleural effusions. A Chest CT scan showed dependent lung consolidation and bilateral ground‐glass opacities with intralobular septal thickening along with small bilateral pleural effusions. C‐reactive protein (CRP) was noted to be highly elevated at 42 mg/dL. Immediately after admission, her respiratory status deteriorated. She was transferred to the pediatric intensive care unit (PICU) and was placed on 30 liters per minute (LPM) with a fraction of inspired oxygen (FiO₂) of 93% high‐flow nasal cannula (HFNC). She was treated empirically with intravenous (IV) ceftriaxone and azithromycin for 48 hours. On day 2 of her admission, her respiratory support required further escalation to continuous positive airway pressure (CPAP) of 8 cmH₂O and FiO₂ of 60% due to progression in dyspnea and hypoxia, and IV methylprednisolone was added to her treatment regimen. Her infectious workup, including respiratory viral panel (RVP), legionella urine antigen, HIV antibodies, and fungitell assay for 1,3 D‐B‐glucan, blood culture urine culture, and stool culture were negative. She remained on CPAP for 4 days before transitioning back to NC and finally to room air before discharge. The methylprednisolone was switched to oral prednisone and slowly tapered over 9 days. Postdischarge spirometry was nonobstructive with a forced expiratory volume over 1 second/forced vital capacity (FEV1/FVC) of 96%; however, DLCO was mildly reduced (72% predicted, also 79% when corrected for alveolar volume, 72% when corrected for hemoglobin). Per CDC guidelines, this case is defined as a confirmed case of EVALI.

A 17‐year‐old male with a past medical history of depression presented to the emergency department (ED) with 3 days of nausea, cough, chest pain, and dyspnea. The patient reported a 4‐year history of daily vaping of nicotine pods and a 1‐week history of THC‐containing product use via an open system device. He stated that symptoms started directly after THC vaping. He was noted to be tachypneic on the exam and unable to speak in full sentences. His vital signs were significant for HR 110, RR 32, SpO₂ 88%, and temperature of 101.3 F. A chest CT scan showed diffuse peripheral and basilar airspace disease. He continued to be tachypneic with hypoxemia on 3 LPM oxygen via NC. He was admitted to the PICU and was started on 25 LPM at FiO₂ of 45% HFNC with the improvement of his pulse oximetry. Ceftriaxone, azithromycin, and IV methylprednisolone were started on day 1 of admission. However, ceftriaxone was discontinued after 3 days. CRP was noted to be highly elevated at 39 mg/dL. Infectious workup, including RVP, mycoplasma antibodies, HIV antibodies, streptococcus pneumonia antigen, legionella urinary antigen, and blood culture, were all negative. He was gradually weaned off HFNC, and on day 8 of admission was placed on NC. He completed a 5‐day course of oral azithromycin and prednisone and was discharged home on room air on day 10. His postdischarge spirometry was nonobstructive with FEV1/FVC of 100%, but DLCO was moderately reduced (64% predicted uncorrected; 70% when corrected for alveolar volume, 69% when corrected for hemoglobin). Per CDC guidelines, this case is defined as a confirmed case of EVALI.

A 17‐year‐old male with a history of hypertension presented to the ED with 4 days of nausea, vomiting, cough, fever, and dyspnea. The patient reported 2 years of daily vaping of nicotine pods in a closed system device as recently as the day of presentation to the ED. However, he denied using any THC products. On exam, he was noted to be tachypneic with crackles noted in the right lower lobe. His vital signs were significant for HR 111, RR 38, and SpO₂ 85%. He was started on 3 L of oxygen via NC, which was quickly advanced to 30 LPM FiO₂ 45% HFNC due to continued hypoxemia. His CXR showed bilateral confluent and patchy airspace opacities. He was admitted directly to the PICU and was started on IV ceftriaxone and azithromycin for 5 days. CRP was noted to be highly elevated at 43 mg/dL. RVP was shown to be positive for rhino/enterovirus. He was weaned from HFNC to NC on day 2 of admission. He was gradually weaned off supplemental oxygen and discharged home on room air on day 6. No steroids were prescribed during his hospitalization. Spirometry on the day of discharge was nonobstructive with FEV1/FVC of 100%. He will follow up in the pediatric pulmonary clinic for spirometry and DLCO testing. Per CDC guidelines, this case is defined as a probable case of EVALI.

A 15‐year‐old male with a history of anxiety and ADHD presented to the ED with dyspnea in the setting of cough and intermittent fevers for 5 days. Upon further inquiry, the patient reported a 3‐month history of vaping nicotine pods and THC‐containing products via an open system device up to the day before the onset of symptoms. He was noted to be tachypneic and appeared anxious. His vital signs were significant for HR 91, RR 36, SpO₂ 88%, and temperature of 98.6 F. He was placed on 2 LPM oxygen via NC on the ED with ongoing tachypnea and anxiety. He was admitted to the PICU and started on 25 LPM at 50% FiO₂ HFNC with an improvement in respiratory status. CXR showed bilateral opacities consolidated in the bases. CRP was noted to be elevated at 28 mg/dL. RVP was negative, but acute mycoplasma lower respiratory tract infection was suspected based on the serology. He was started on oral azithromycin for 5 days. He was weaned off HFNC to NC on day 5 of admission and finally to room air before discharge on day 7. Postdischarge spirometry showed mild airway obstruction with FEV1/FVC of 75%. DLCO carried out on this patient was also mildly reduced (75% predicted uncorrected; 72% when corrected for alveolar volume). DLCO was not corrected for hemoglobin for this patient. Per CDC guidelines, this case is defined as a probable case of EVALI.

A 17‐year‐old female with a past medical history of gastroesophageal reflux disease and anxiety presented to the ED with a history of fever, cough, nausea, vomiting, and abdominal pain of 5 days duration. She was tachycardic and exhibited bilateral costovertebral angle, and right lower quadrant tenderness on exam. Her vital signs were significant for HR 120, RR 18, SpO₂ 94%, and temperature of 99 F. The patient reported several months of daily use of a THC vape pen device up to 1 week before the onset of illness. An abdomen and pelvis CT scan was performed in the ED. No intra‐abdominal pathology was identified; however, lung bases displayed bilateral interstitial changes. A CXR was performed, which confirmed interstitial and airspace opacities bilaterally, most notably in the left lower lobe. She was admitted to the pediatric inpatient floor and was started on IV ceftriaxone and azithromycin. CRP was elevated at 35 mg/dL. As her RVP was negative, and she remained afebrile, both antibiotics were discontinued on day 1 of admission. She was started on 60 mg of oral prednisone once a day and continued to improve on steroids alone with no further respiratory symptoms. She did not require any supplemental oxygen during her admission. She completed a 5‐day course of oral prednisone and was discharged home. In follow‐up at the pediatric pulmonary clinic, her symptoms had resolved. She had a suboptimal technique during spirometry maneuvers, and we were unable to interpret the study. She will return for further spirometry and DLCO at her next follow‐up. Per CDC guidelines, this case is defined as a confirmed case of EVALI.

A 16‐ year‐old female with a past medical history of intermittent asthma, irritable bowel syndrome, and anxiety presented to the ED with 2 days of chest pain, fever, and dyspnea. The patient reported a 1‐year history of daily vaping of nicotine pods and a THC‐containing product via an open system device. Her vital signs were significant for HR 132, RR 20, and SpO₂ 99%. CRP was noted to be elevated at 35 mg/dL. IV ceftriaxone was started on admission. Extensive workup, including blood cultures, urine cultures, RVP, cytomegalovirus, Epstein‐Barr virus, HIV, Bartonella, legionella urine PCR, syphilis, creatinine kinase, ferritin, electrocardiogram, and echocardiogram showed normal findings. Chest CT scan revealed bilateral diffuse interstitial infiltrates, and CXR showed diffuse fine reticular interstitial opacities. Despite the lack of hypoxemia, the patient requested oxygen via NC for relief of dyspnea and was placed on 0.5 LPM. A flexible fiberoptic bronchoscopy was performed, which showed no evidence of tracheobronchitis such as edema or erythema of airway mucosa. Bronchoalveolar lavage was negative for bacterial culture, pneumocystis jirovecii by quantitative PCR, and acid‐fast bacilli. She was gradually weaned off supplemental oxygen as symptoms of dyspnea and chest pain resolved and discharged home on day 8. In a follow‐up, spirometry carried out 2 weeks postdischarge was nonobstructive with an FEV1/FVC of 95%. Per CDC guidelines, this case is defined as a confirmed case of EVALI.

An 18‐year‐old previously healthy male presented to ED with 4 days of productive cough and dyspnea. His vital signs were significant for HR 84, RR 18, SpO₂ 98%, and temperature of 100.4 F. The patient reported a 1‐year history of daily vaping of nicotine pods and a THC‐containing product via an open system device. Rapid flu and respiratory syncytial virus were negative. A chest CT scan showed peribronchial thickening, centrilobular nodules, and tree‐in‐bud pattern noted bilaterally. The patient had stable vital signs throughout the ED stay and did not require any supplemental oxygen. He was discharged on oral doxycycline for 10 days. The patient was ultimately lost to follow‐up. In this patient, no infectious cause was found, however, the workup was not as robust as the previous cases. As such, we have classed this case as a probable EVALI case per CDC guidelines.