Association of methylenetetrahydrofolate reductase C677T polymorphism with lacunar infarction: A systematic review and meta-analysis.

First designated in 2019, e-cigarette or vaping product use–associated lung injury (EVALI) represents a distinct clinical entity of acute or subacute respiratory illness attributable to the use of e-cigarettes or vaping products. Epidemiologically, the majority of EVALI cases have been reported in the United States, predominantly affecting adolescents and young adults, with a consistent male predominance across cohorts. The clinical burden of EVALI is substantial: pooled estimates indicate that 94.4% of patients require hospitalization, 35.7% require intensive care unit admission, and the overall mortality rate is 0.9%, underscoring the critical acuity of this condition. The clinical spectrum of EVALI encompasses manifestations ranging from asymptomatic presentations to respiratory compromise and, in severe cases, respiratory failure. In addition to pulmonary involvement, a subset of patients may present with concurrent gastrointestinal, cardiac, and systemic symptoms, including nausea, vomiting, chest pain, fever, and weight loss. In current literature, among reported cases of patients, there have only been 3 patients who lacked pulmonary symptoms. Herein, we report on a patient with EVALI who lacked typical pulmonary symptoms throughout the clinical course. We review the pertinent literature to enhance clinical recognition, facilitate accurate diagnosis, and guide appropriate management of this respiratory illness. A 33-year-old male presented to the Otolaryngology Department of Guangdong Clifford Hospital on August 17, 2023, for recurrent nasal congestion lasting over a year. After admission, chest noncontrast computed tomography (CT) revealed scattered opacities in both lungs (Fig. A and B), prompting his transfer to the Respiratory Department for further management. His symptoms included nasal congestion, intermittent minor epistaxis, occasional nasal itching, sneezing, clear rhinorrhea, and snoring during sleep. Treatment with budesonide nasal spray for 2 weeks showed no improvement. The patient had no pulmonary complaints such as cough, shortness of breath, or chest pain upon admission. He had used e-cigarettes with mung bean flavoring for 3 years, with a daily consumption of 7 to 13 puffs, and had a previous 10-year history of tobacco smoking at 15 cigarettes per day. The patient had no history of dust or other allergies and no other medical history. Comparison of baseline and follow-up chest CT scans. (A/a, B/b) Baseline imaging shows multiple scattered opacities in both lungs. A large, patchy consolidation with an air bronchogram is present in the anterior medial basal segment of the left lower lobe. On contrast‑enhanced series, the lesion demonstrates moderate progressive enhancement. (C/c) After ineffective anti‑infective therapy, the pulmonary lesions increased in both number and size(arrows). (D/d) Following glucocorticoid treatment, the areas of pulmonary infiltration decreased compared with previous scans(arrows). (E/e) At the 2‑year follow-up, the lung lesions had resolved substantially, with only minor organized foci remaining in the left lower lobe(arrows).