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E-cigarette or vaping product use-associated lung injury (EVALI) masquerading as COVID-19
  1. Nandita Ganne1,
  2. Raj Palraj2,
  3. Elizabeth Husted1 and
  4. Ishan Shah1
  1. 1Family Medicine, Mayo Clinic Health System, La Crosse, Wisconsin, USA
  2. 2Infectious Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  1. Correspondence to Dr Nandita Ganne; ganne.nandita{at}


SARS-CoV-2, the novel coronavirus causing COVID-19, has caused a global pandemic resulting in over 4 million deaths globally (data current as of 14 July 2021). E-cigarette or vaping product use-associated lung injury (EVALI) is a type of acute lung injury of unclear pathogenesis. The two pathologies present with overlapping clinical symptoms, laboratory values and imaging, making them difficult to distinguish, especially in the setting of a global COVID-19 pandemic. We present the case of a 32-year-old woman treated for COVID-19 despite multiple negative SARS CoV-2 PCR tests and nucleocapsid antibody test. On further investigation, she endorsed use of E-cigarettes and was subsequently diagnosed with EVALI. The patient was treated with oral and intravenous steroids, resulting in significant improvement in her symptoms. This case highlights the challenge of diagnosing rarer aetiologies of respiratory distress during the COVID-19 pandemic.

  • COVID-19
  • adult intensive care
  • drugs misuse (including addiction)
  • pneumonia (respiratory medicine)
  • tobacco related disease

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  • Contributors All authors contributed to the development and revision of the manuscript. NG was involved in conduct, reporting, acquisition of data and interpretation of data. EH contributed to acquisition, analysis and writing the manuscript. IS contributed to conduct, analysis, interpretation of data and editing the manuscript. RP was involved in design, conduct, interpretation of data and editing of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.