EVALI versus MIS-C, one more overlapping diagnosis to consider.

Area of Science:

• Pediatric critical care
• Pulmonology
• Infectious disease

Background:

• Multisystem inflammatory syndrome in children (MIS-C) and E-cigarette, or vaping, product use-associated lung injury (EVALI) share overlapping symptoms.
• The COVID-19 pandemic complicates the diagnosis of these conditions.

Purpose of the Study:

• To describe cases of EVALI misdiagnosed as MIS-C.
• To highlight diagnostic challenges in differentiating EVALI from MIS-C.

Main Methods:

• Case series of six adolescent patients.
• Clinical presentation, laboratory findings, and imaging studies were reviewed.
• Diagnostic criteria for MIS-C and EVALI were applied.

Main Results:

• Patients presented with fever and severe abdominal symptoms.
• Laboratory tests showed elevated inflammatory markers, lymphopenia, and increased D-dimers.
• Imaging revealed airspace disease and ground-glass opacities; SARS-CoV-2 tests were negative.
• All patients had a history of vaping, leading to EVALI diagnosis.

Conclusions:

• EVALI can mimic MIS-C, posing a diagnostic challenge.
• Vaping history is crucial for diagnosing EVALI, especially during the COVID-19 pandemic.
• Awareness of EVALI's overlapping features with MIS-C is essential for accurate diagnosis and management.