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American Academy of Pediatrics
Case Report

Anaerobic Necrotizing Pneumonia: Another Potential Life-threatening Complication of Vaping?

Hassan El Chebib, Kiah McArthur, Michelle Gorbonosov and Joseph B. Domachowske
Pediatrics April 2020, 145 (4) e20193204; DOI: https://doi.org/10.1542/peds.2019-3204
Hassan El Chebib
Department of Pediatrics, Upstate Medical University, State University of New York, Syracuse, New York
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Kiah McArthur
Department of Pediatrics, Upstate Medical University, State University of New York, Syracuse, New York
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Michelle Gorbonosov
Department of Pediatrics, Upstate Medical University, State University of New York, Syracuse, New York
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Joseph B. Domachowske
Department of Pediatrics, Upstate Medical University, State University of New York, Syracuse, New York
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Abstract

An adolescent girl with a history of frequent electronic cigarette use of nicotine was hospitalized with severe necrotizing pneumonia. Blood cultures obtained before the administration of empirical broad-spectrum intravenous antibiotics had positive results for the growth of Fusobacterium necrophorum. The pathogen is an uncommon but well-known cause of anaerobic pneumonia with unique features that are collectively referred to as Lemierre syndrome or postanginal sepsis. The syndrome begins as a pharyngeal infection. Untreated, the infection progresses to involve the ipsilateral internal jugular vein, resulting in septic thrombophlebitis with direct spread from the neck to the lungs causing multifocal necrotizing pneumonia. The teenager we present in this report had neither a preceding pharyngeal infection nor Doppler ultrasonographic evidence for the presence of deep neck vein thrombi, leading us to explore alternative mechanisms for her pneumonia. We propose the possibility that her behavior of frequent vaping led to sufficient pharyngeal irritation such that F necrophorum colonizing her oropharynx was inhaled directly into her lungs during electronic cigarette use. Preexisting, but not yet recognized, vaping-related lung injury may have also contributed to her risk of developing the infection. The patient was hospitalized for 10 days. At follow-up one month later, she still became short of breath with minimal exertion.

  • Accepted January 28, 2020.
  • Copyright © 2020 by the American Academy of Pediatrics

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Pediatrics
Vol. 145, Issue 4
1 Apr 2020
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Anaerobic Necrotizing Pneumonia: Another Potential Life-threatening Complication of Vaping?
Hassan El Chebib, Kiah McArthur, Michelle Gorbonosov, Joseph B. Domachowske
Pediatrics Apr 2020, 145 (4) e20193204; DOI: 10.1542/peds.2019-3204

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Anaerobic Necrotizing Pneumonia: Another Potential Life-threatening Complication of Vaping?
Hassan El Chebib, Kiah McArthur, Michelle Gorbonosov, Joseph B. Domachowske
Pediatrics Apr 2020, 145 (4) e20193204; DOI: 10.1542/peds.2019-3204
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