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SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The SARS-CoV-2 pandemic spawned the use and study of novel therapeutics, re-purposed drugs, and interventions– all with limited success. Seraph® 100 Microbind Affinity Blood Filter® [Seraph®] is an investigational device that was given Emergency Use Authorization (EUA) by the Food and Drug Administration in 2019 to treat severe coronavirus disease. Higher viremia is correlated with higher mortality. Seraph® uses extracorporeal filtration to aid the innate immune system by reducing viral load and mitigating downstream effects of inflammation. CASE PRESENTATION: A forty-eight year old gentleman presented to the emergency room with coughs and fever of 101° F. He tested positive via polymerase chain reaction [PCR] testing for SARS-CoV-19 pneumonia. A computed-tomography angiogram [CTA] of the chest was negative for pulmonary embolism, but demonstrated significant bilateral ground-glass opacities consistent with viral pneumonia. Vitals were notable for an oxygen saturation of 69% on room air that improved to 96% on 6 liters/minute [L/min] of supplemental oxygen via nasal cannula. He was initiated on both dexamethasone and remdesivir. Within hours, the patient's oxygen requirements escalated to 15 L/min via non-rebreather to high flow humidified nasal cannula with a flow rate of 40 L/min and 60% FiO2. On day three, he was transferred to the ICU for treatment with Seraph®. After one treatment, the patient was weaned from high flow humidified nasal cannula to room air. On day five, after a second treatment, he transferred to the floor. He was discharged on day six, on room air, having completed his course of remdesivir, with an additional 5 days of oral steroids. DISCUSSION: Preliminary data regarding Seraph® remain limited with only select eligible patients undergoing therapy. Cases like our patient demonstrate dramatic improvements with even one or two treatments which correlate well with data that show up to 99% reduction in the bloodstream of targeted pathogens per pass. While database collection data have revealed trends towards improved outcomes, further investigation into populations most likely to benefit from treatment is needed. Timing, immunocompromised status and other comorbidities that raise or lower the chances of successful hemofiltration need to be considered. CONCLUSIONS: Studies in the SARS-CoV-2 pandemic augment ongoing research as filtration devices are used to target bacterial infections, cytokines and inflammatory markers. Since the invention of antibiotics, multi-drug resistant organisms have increased in prevalence. Novel interventions such as Seraph® warrant investigation to prevent infectious diseases from becoming unmanageable threats. Reference #1: Kielstein JT, Borchina DN, Fühner T, Hwang S, Mattoon D, Ball AJ. Hemofiltration with the Seraph® 100 Microbind® Affinity filter decreases SARS-CoV-2 nucleocapsid protein in critically ill COVID-19 patients. Crit Care. 2021;25(1):190. Published 2021 Jun 1. doi:10.1186/s13054-021-03597-3 Reference #2: Pape A, Kielstein JT, Krüger T, Fühner T, Brunkhorst R. Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter. TH Open. 2021;5(2):e134-e138. Published 2021 Apr 14. doi:10.1055/s-0041-1727121 Reference #3: Schmidt JJ, Borchina DN, van T Klooster M, et al. Interim-analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry [published online ahead of print, 2021 Dec 7]. Nephrol Dial Transplant. 2021;gfab347. doi:10.1093/ndt/gfab347 DISCLOSURES: No relevant relationships by Aneesa Afroze No relevant relationships by Lydia Meece No relevant relationships by Angela Park
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INTRODUCTION: E-cigarette or vaping associated lung injury (EVALI) is an uncommon complication of e-cigarettes or vaping. 96% of these cases require hospitalization. The condition is especially associated with tetrahydrocannabinol (THC) products, frequent use, and is found primarily in young adults. “Dabbing” refers to the process of heating THC containing oils or waxes with butane solvents to vaporize cannabinoids for inhalation. CASE REPORT: An obese 20-year-old college male with a history of prematurity and anxiety presented with cough, dyspnea, nausea, vomiting and diarrhea that began 3 days prior. He reported smoking marijuana, but denied vaping. Multiple PCR tests for SARS-CoV-2 were negative. Initial chest radiograph demonstrated multifocal pneumonia. He was hypoxic on presentation requiring two liters of oxygen via nasal cannula. Broad spectrum antibiotics for pneumonia and steroids were initiated. Oxygen requirements rapidly increased and humidified high flow oxygen was instituted and escalated to 60 liters per minute and 90 % FiO2. He remained hypoxic, prompting intubation 48 hours from presentation. His ventilatory settings were steadily escalated to a positive end expiratory pressure of 15 cm H2O with 100% FiO2. Despite this, the patient had oxygenation saturations as low as 57% requiring transition to venovenous extracorporeal membrane oxygenation (VV-ECMO). Computed tomography angiography ruled out pulmonary embolism but redemonstrated extensive alveolar and interstitial infiltrates bilaterally. Bronchoscopy with alveolar lavage was performed with negative cultures and cytology. Blood cultures were also negative and antibiotic therapy was stopped. Extensive laboratory investigation for autoimmune vasculitis was performed and found to be negative. Discussion with family revealed that the patient regularly inhaled concentrated THC wax with butane as a solvent. Treatment continued with high dose intravenous steroids and supportive care. The patient received a total of 5 days of ventilator support after which he was extubated, and an additional 5 days of VV-ECMO. At discharge, the patient required 2 liters of continuous oxygen at rest and 4 liters with activity. He was otherwise asymptomatic and at his baseline level of function. He was discharged on daily steroids with taper and close outpatient follow up. DISCUSSION: While the majority of hospitalized patients with EVALI require intubation, the necessity of VV-ECMO utilization represents a rare severe presentation. Dabbing remains a rare cause of acute respiratory distress syndrome and EVALI, however, dabbing is emerging as a trend among young adults and represents an under-investigated cause of severe inhalational lung injury.