Hot Dab Associated Pneumonitis - A Case Report

Hot Dab Associated Pneumonitis - A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Hot Dab Associated Pneumonitis - A Case Report Ratika Dogra, Vallabh Dogra, Himani Badyal, Salil Avasthi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4249247/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Sep, 2024 Read the published version in BMC Pulmonary Medicine → Version 1 posted 14 You are reading this latest preprint version Abstract Background Dabbing is recently getting popular in young adults. It is a new method of using the most active form of marijuana where large amount of concentrated tetrahydrocannabinol is inhaled. Tetrahydrocannabinol is associated with a feeling of ‘High’ which make the user feel joyous and relaxed. With increasing use of such technique, dabbing becomes an important differential for evaluation of acute respiratory failure with pneumonitis specially in adult population. Case presentation We present a case report of 51 years old Caucasian male who presented to hospital with chest pressure and shortness of breath. Patient was noted to be hypoxic desaturating down to 82-83% on nasal cannula oxygen. Imaging revealed concern for multifocal pneumonia. Patient required use of high flow oxygen. Patient was started on broad spectrum antibiotics and intravenous corticosteroids. Patient had gradual improvement in his symptoms and was able to come off oxygen completely. Patient was discharged home on prednisone taper. Conclusions Dabbing is a newer technique which has been gaining popularity for marijuana usage. With legalization of marijuana newer techniques are getting popular. Our case report emphasizes the importance of keeping dabbing as a differential when patient presents with respiratory failure and has concerns for pneumonitis. Patients might not reveal until specifically asked about their practices. Dabbing Pneumonitis Hypoxia Tetrahydrocannabinol Figures Figure 1 BACKGROUND Dabbing is commonly in young population with increasing use of marijuana use. The active form of Marijuana called tetrahydrocannabinol is associated of feeling of pleasure and dabbing results in inhalation of large amount of this active substance. We present a case of acute respiratory failure caused by dabbing leading to pneumonitis and lung injury with patient needing high amount of oxygen. We often include e-cigarettes and vaping in our differential diagnosis when we evaluate acute respiratory failure without clear cause however some people might not reveal about dabbing unless enquired about. These patients respond fairly well to steroids and timely diagnosis can help in effective treatment. CASE REPORT 51 years old Caucasian male with past medical history of anxiety, previous motor vehicle accident with right below knee amputation, no previous pulmonary issues presented to the hospital with shortness of breath, chest pressure and cough. Symptoms started around a week before hospital presentation. Patient initially went to urgent care where he was noted to have hypoxia down to 80s. He was transferred to hospital emergency room. Patient did report chills with some subjective fevers. He was beginning to bring up some pinkish colored phlegm. He reported worsening shortness of breath even at rest with pressure in the chest which was non-radiating. Patient reported that symptoms were worsening over course of 7 days. Patient denied any recent viral illness, no occupational exposure, no use of vaping or e-cigarettes. On further questioning and digging in the history patient revealed that he had been dabbing with his friends. Initial vitals showed pulse of 56, Tmax97.7, bp 109/60. Labs showed normal creatinine, hypokalemia with potassium 3.5. Blood counts showed elevated white count of 13.4, hemoglobin 13.6, normal platelets 176. Troponin was 33, trended down to 22. Patient was requiring oxygen support and was getting hypoxic 82–83% on simple nasal cannula oxygen. Patient was then started on high flow oxygen which maintained his oxygenation aboe 90%. Chest Xray showed concern for bilateral infiltrates. CT scan of chest was concerning for multifocal pneumonia with ground glass opacities, refer to Fig. 1 . Patient was started on broad spectrum antibiotics, corticosteroids and breathing treatments. Over the course of next several days patient showed gradual improvement. Patient was able to come off high flow oxygen and was discharged home on oral prednisone. DISCUSSION The term dabbing is jargon that refers to the inhalation of vapors derived from marijuana-based oils, concentrates, and extracts. 1 Smoking or inhaling marijuana through joints or bongs, or ingesting through eating, remain common ways, but another delivery method, dabbing, is undergoing scrutiny as more and more young person engage in it. 2 Dabbing is increasingly getting popular in teenagers and young adults. Cannabis dabbing is a mode of recreational use of marijuana where extremely concentrated tetrahydrocannabinol (THC) vapors are inhaled. 3 These preparations are made by extracting TCH from cannabis through a process that uses butane gas. These preparations are called butane hash oil (BHO) and are more potent than flower cannabis. 4 THC is the ingredient responsible for the “high” associated with marijuana use—feelings of euphoria, increased insightfulness, heightened sociability, sexual pleasure, and relaxation that many users say that they experience and enjoy. 5 Term “dab” refers to an amount of BHO product associated with a single use while “dabbing” refers to the act of administering that product. 6 The exact underlying pathophysiological mechanism behind dabbing induced pneumonitis is unclear, but it could be related to direct inhalation injury and maladaptive host immune response induced by butane or other impurities. 7 Chemical induced pneumonitis is frequently associated with vacuolated pneumocytes and lipid laden macrophages. 8 Homemade dabs and/or dabs obtained from an undependable source may contain residual solvents and other toxic substances including butane, pesticides, and conceivably carcinogenic contaminants. 9 Imaging can reveal bilateral infiltrates with picture of possible pneumonia. Chest CT images show diffuse centrilobular nodules and tree-in-bud pattern and a histopathologic pattern of organizing pneumonia with or without patchy acute alveolar damage. 10 Treatment strategy involves complete avoidance of trigger, supportive care with oxygen till lungs get time to recover. Steroids play the mainstay for treatment for induced pneumonitis. Although the general goal is to aim for the lowest-possible dose and shortest duration, the dosage and duration of treatment have not been determined in any study. 11 CONCLUSION Dabbing is a new recently becoming popular means for marijuana use. Dabbing can cause hypoxic respiratory failure with pneumonitis. It can be confused with possible multifocal pneumonia. Dabbing should be considered whenever we are considered substance associated lung injury like considering e-cigarette or vaping use-associated lung injury (EVALI). These cases respond well to corticosteroids and thus timely diagnosis by keeping it in the differential is very important. Declarations A) Ethics approval and consent- Not Applicable B) Written informed consent for publication was obtained from the participant of the case report C) Availability of Data and material- All data generated or analyzed during the study are included in this published article. D) Conflict of interest- There are no financial and non-financial competing interests for all authors involved in case report. E) Funding- Mercy St Vincent Medical Center will help with funding and cost of publication F) Author’s contributions as follows- Ratika Dogra MD: Primary author, did chart review, analyzed, interpreted data, collected images, wrote the case presentation, edited the case discussion Vallabh Dogra MD: Analysed and interpreted the data, wrote the case presentation, helped in writing the pathophysiology, evaluation and treatment Himani Badyal: Helped in writing abstract, discussion Salil Avasthi MD: Helped in chart review, writing abstract, treatment strategy, final editing of report All authors read and approved the final manuscript. G) Acknowledgements- not applicable Author Contribution Ratika Dogra MD: Primary author, did chart review, analyzed, interpreted data, collected images, wrote the case presentation, edited the case discussion.Vallabh Dogra MD: Analysed and interpreted the data, wrote the case presentation, helped in writing the pathophysiology, evaluation and treatment.Himani Badyal: Helped in writing abstract, discussion part.Salil Avasthi MD: Helped in chart review, writing abstract, treatment strategy, final editing of report. References Centers for Disease Control and Prevention. Marijuana and public health. How is marijuana used? 2018. Nierengarten, M. B. (2016). Dabbling in'dabbing': a potent new delivery system for cannabis poses heightened risks for adolescents who use marijuana. Contemporary Pediatrics , 33 (2), 34–36. Miller, B. L., Stogner, J. M., & Miller, J. M. (2016). Exploring butane hash oil use: a research note. Journal of psychoactive drugs , 48 (1), 44–49. DualDiagnosis.org. BHO and butane toxicity. 2020. https://dualdiagnosis.org/marijana-treatment/bho-butane-toxicity/ Murray, R. M., Quigley, H., Quattrone, D., Englund, A., & Di Forti, M. (2016). Traditional marijuana, high‐potency cannabis and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry , 15 (3), 195–204. Stogner, J. M., & Miller, B. L. (2015). The dabbing dilemma: A call for research on butane hash oil and other alternate forms of cannabis use. Substance abuse , 36 (4), 393–395. McMahon, M. J., Bhatt, N. A., Stahlmann, C. G., & Philip, A. I. (2016). Severe Pneumonitis after Inhalation of Butane Hash Oil. Annals of the American Thoracic Society , 13 (6), 991–992. https://doi.org/10.1513/AnnalsATS.201602-101LE Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M. W., Navon, L., Hoots, B., Salvatore, P. P., Elderbrook, M., Haupt, T., Kanne, J., Patel, M. T., Saathoff-Huber, L., King, B. A., Schier, J. G., Mikosz, C. A., & Meiman, J. (2020). Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. The New England journal of medicine , 382 (10), 903–916. https://doi.org/10.1056/NEJMoa1911614 Alzghari, S. K., Fung, V., Rickner, S. S., Chacko, L., & Fleming, S. W. (2017). To dab or not to dab: rising concerns regarding the toxicity of cannabis concentrates. Cureus , 9 (9). Berkowitz, E. A., Henry, T. S., Veeraraghavan, S., Staton, G. W., Jr, & Gal, A. A. (2015). Pulmonary effects of synthetic marijuana: chest radiography and CT findings. AJR. American journal of roentgenology , 204 (4), 750–757. https://doi.org/10.2214/AJR.14.13138 Kokkarinen, J. I., Tukiainen, H. O., & Terho, E. O. (1992). Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung. The American review of respiratory disease , 145 (1), 3–5. https://doi.org/10.1164/ajrccm/145.1.3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Sep, 2024 Read the published version in BMC Pulmonary Medicine → Version 1 posted Editorial decision: Revision requested 18 Jul, 2024 Reviews received at journal 15 Jul, 2024 Reviews received at journal 12 Jul, 2024 Reviews received at journal 07 Jul, 2024 Reviewers agreed at journal 07 Jul, 2024 Reviewers agreed at journal 05 Jul, 2024 Reviewers agreed at journal 03 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers invited by journal 25 Jun, 2024 Editor assigned by journal 19 Jun, 2024 Editor invited by journal 17 Apr, 2024 Submission checks completed at journal 17 Apr, 2024 First submitted to journal 10 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4249247","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":293685952,"identity":"b77fe14e-2a2d-45fb-ba7c-61f06b1335ac","order_by":0,"name":"Ratika Dogra","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYJCCgw0MDIwNINaHChsgydh4AL8GZoQWxhln0kBUA0EtjDAtzLwth8FieLWYt58/eHBGDYNsP//ahx94G87brW0/DLSlxiYalxaZM8kMBzccYzCeOeO5sYTkjtvJ284kArUcS8ttwKFFggGo5QEbQ+KGG8cYJAzP3E42OwDUwthwGLcW/sdALf/AWph/JLadSzY7/5CAFgmgLRvbgFrOt7FJHGw7YGd2g5AtEo8NDs7skwD6hY3NsuFMcoLZDaAtCfj8wp/4+GPPNxtgiB1jvv2nws7e7Hz6wwcfamxwaoGHAoNEApiVCFaZgF85FPAfAFP2RCkeBaNgFIyCEQUAFtxryTcn7/AAAAAASUVORK5CYII=","orcid":"","institution":"Mercy St Vincent medical center","correspondingAuthor":true,"prefix":"","firstName":"Ratika","middleName":"","lastName":"Dogra","suffix":""},{"id":293685954,"identity":"07dc78e0-66d4-4820-9c55-8b01018dffd2","order_by":1,"name":"Vallabh Dogra","email":"","orcid":"","institution":"Mercy St Vincent medical center","correspondingAuthor":false,"prefix":"","firstName":"Vallabh","middleName":"","lastName":"Dogra","suffix":""},{"id":293685956,"identity":"73a62050-072e-414d-b002-a1b05ad4af3a","order_by":2,"name":"Himani Badyal","email":"","orcid":"","institution":"Mercy St Vincent medical center","correspondingAuthor":false,"prefix":"","firstName":"Himani","middleName":"","lastName":"Badyal","suffix":""},{"id":293685958,"identity":"27f6ca58-0fad-4f7f-ace9-7f88b06fbbc6","order_by":3,"name":"Salil Avasthi","email":"","orcid":"","institution":"Mercy St Vincent medical center","correspondingAuthor":false,"prefix":"","firstName":"Salil","middleName":"","lastName":"Avasthi","suffix":""}],"badges":[],"createdAt":"2024-04-10 21:20:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4249247/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4249247/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12890-024-03255-8","type":"published","date":"2024-09-13T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55323599,"identity":"bf35ce47-17fa-49f4-acbc-26ebd0c60533","added_by":"auto","created_at":"2024-04-25 16:45:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":301918,"visible":true,"origin":"","legend":"\u003cp\u003eCT scan chest showing multifocal infiltrates\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4249247/v1/5325f5e7c2d8acb8e654bf18.png"},{"id":64619100,"identity":"ce0ab6df-9bda-4d88-907c-cfe8053bd6e5","added_by":"auto","created_at":"2024-09-16 16:11:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":459064,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4249247/v1/48e39c9f-acaf-46ad-b98e-bb61fa2308e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHot Dab Associated Pneumonitis - A Case Report\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDabbing is commonly in young population with increasing use of marijuana use. The active form of Marijuana called tetrahydrocannabinol is associated of feeling of pleasure and dabbing results in inhalation of large amount of this active substance. We present a case of acute respiratory failure caused by dabbing leading to pneumonitis and lung injury with patient needing high amount of oxygen. We often include e-cigarettes and vaping in our differential diagnosis when we evaluate acute respiratory failure without clear cause however some people might not reveal about dabbing unless enquired about. These patients respond fairly well to steroids and timely diagnosis can help in effective treatment.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003e51 years old Caucasian male with past medical history of anxiety, previous motor vehicle accident with right below knee amputation, no previous pulmonary issues presented to the hospital with shortness of breath, chest pressure and cough. Symptoms started around a week before hospital presentation. Patient initially went to urgent care where he was noted to have hypoxia down to 80s. He was transferred to hospital emergency room. Patient did report chills with some subjective fevers. He was beginning to bring up some pinkish colored phlegm. He reported worsening shortness of breath even at rest with pressure in the chest which was non-radiating. Patient reported that symptoms were worsening over course of 7 days. Patient denied any recent viral illness, no occupational exposure, no use of vaping or e-cigarettes. On further questioning and digging in the history patient revealed that he had been dabbing with his friends. Initial vitals showed pulse of 56, Tmax97.7, bp 109/60. Labs showed normal creatinine, hypokalemia with potassium 3.5. Blood counts showed elevated white count of 13.4, hemoglobin 13.6, normal platelets 176. Troponin was 33, trended down to 22. Patient was requiring oxygen support and was getting hypoxic 82\u0026ndash;83% on simple nasal cannula oxygen. Patient was then started on high flow oxygen which maintained his oxygenation aboe 90%. Chest Xray showed concern for bilateral infiltrates.\u003c/p\u003e \u003cp\u003eCT scan of chest was concerning for multifocal pneumonia with ground glass opacities, refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatient was started on broad spectrum antibiotics, corticosteroids and breathing treatments. Over the course of next several days patient showed gradual improvement. Patient was able to come off high flow oxygen and was discharged home on oral prednisone.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe term \u003cem\u003edabbing\u003c/em\u003e is jargon that refers to the inhalation of vapors derived from marijuana-based oils, concentrates, and extracts.\u003csup\u003e1\u003c/sup\u003e Smoking or inhaling marijuana through joints or bongs, or ingesting through eating, remain common ways, but another delivery method, dabbing, is undergoing scrutiny as more and more young person engage in it.\u003csup\u003e2\u003c/sup\u003e Dabbing is increasingly getting popular in teenagers and young adults. \u0026nbsp;Cannabis dabbing is a mode of recreational use of marijuana where extremely concentrated tetrahydrocannabinol (THC) vapors are inhaled. \u003csup\u003e3\u003c/sup\u003e These preparations are made by extracting TCH from cannabis through a process that uses butane gas. These preparations are called butane hash oil (BHO) and are more potent than flower cannabis.\u003csup\u003e4\u003c/sup\u003e THC is the ingredient responsible for the \u0026ldquo;high\u0026rdquo; associated with marijuana use\u0026mdash;feelings of euphoria, increased insightfulness, heightened sociability, sexual pleasure, and relaxation that many users say that they experience and enjoy.\u003csup\u003e5\u003c/sup\u003e\u0026nbsp; Term \u0026ldquo;dab\u0026rdquo; refers to an amount of BHO product associated with a single use while \u0026ldquo;dabbing\u0026rdquo; refers to the act of administering that product.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe exact underlying pathophysiological mechanism behind dabbing induced pneumonitis is unclear, but it could be related to direct inhalation injury and maladaptive host immune response induced by butane or other impurities.\u003csup\u003e7\u003c/sup\u003e Chemical induced pneumonitis is frequently associated with vacuolated pneumocytes and lipid laden macrophages. \u003csup\u003e8\u003c/sup\u003e Homemade dabs and/or dabs obtained from an undependable source may contain residual solvents and other toxic substances including butane, pesticides, and conceivably carcinogenic contaminants.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eImaging can reveal bilateral infiltrates with picture of possible pneumonia. Chest CT images show diffuse centrilobular nodules and tree-in-bud pattern and a histopathologic pattern of organizing pneumonia with or without patchy acute alveolar damage.\u003csup\u003e10\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTreatment strategy involves complete avoidance of trigger, supportive care with oxygen till lungs get time to recover. Steroids play the mainstay for treatment for induced pneumonitis. Although the general goal is to aim for the lowest-possible dose and shortest duration, the dosage and duration of treatment have not been determined in any study. \u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eDabbing is a new recently becoming popular means for marijuana use. Dabbing can cause hypoxic respiratory failure with pneumonitis. It can be confused with possible multifocal pneumonia. Dabbing should be considered whenever we are considered substance associated lung injury like considering e-cigarette or vaping use-associated lung injury (EVALI). These cases respond well to corticosteroids and thus timely diagnosis by keeping it in the differential is very important.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eA) Ethics approval and consent- Not Applicable\u003c/p\u003e \u003cp\u003e B) Written informed consent for publication was obtained from the participant of the case report\u003c/p\u003e \u003cp\u003eC) Availability of Data and material- All data generated or analyzed during the study are included in this published article.\u003c/p\u003e \u003cp\u003eD) Conflict of interest- There are no financial and non-financial competing interests for all authors involved in case report.\u003c/p\u003e \u003cp\u003eE) Funding- Mercy St Vincent Medical Center will help with funding and cost of publication\u003c/p\u003e \u003cp\u003eF) Author\u0026rsquo;s contributions as follows-\u003c/p\u003e \u003cp\u003eRatika Dogra MD: Primary author, did chart review, analyzed, interpreted data, collected images, wrote the case presentation, edited the case discussion\u003c/p\u003e \u003cp\u003eVallabh Dogra MD: Analysed and interpreted the data, wrote the case presentation, helped in writing the pathophysiology, evaluation and treatment\u003c/p\u003e \u003cp\u003eHimani Badyal: Helped in writing abstract, discussion\u003c/p\u003e \u003cp\u003eSalil Avasthi MD: Helped in chart review, writing abstract, treatment strategy, final editing of report\u003c/p\u003e \u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e \u003cp\u003eG) Acknowledgements- not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRatika Dogra MD: Primary author, did chart review, analyzed, interpreted data, collected images, wrote the case presentation, edited the case discussion.Vallabh Dogra MD: Analysed and interpreted the data, wrote the case presentation, helped in writing the pathophysiology, evaluation and treatment.Himani Badyal: Helped in writing abstract, discussion part.Salil Avasthi MD: Helped in chart review, writing abstract, treatment strategy, final editing of report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Centers for Disease Control and Prevention. Marijuana and public health. How is marijuana used? 2018.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Nierengarten, M. B. (2016). Dabbling in'dabbing': a potent new delivery system for cannabis poses heightened risks for adolescents who use marijuana.\u0026nbsp;\u003cem\u003eContemporary Pediatrics\u003c/em\u003e,\u0026nbsp;\u003cem\u003e33\u003c/em\u003e(2), 34\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Miller, B. L., Stogner, J. M., \u0026amp; Miller, J. M. (2016). Exploring butane hash oil use: a research note.\u0026nbsp;\u003cem\u003eJournal of psychoactive drugs\u003c/em\u003e,\u0026nbsp;\u003cem\u003e48\u003c/em\u003e(1), 44\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026nbsp;DualDiagnosis.org. BHO and butane toxicity. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dualdiagnosis.org/marijana-treatment/bho-butane-toxicity/\u003c/span\u003e\u003cspan address=\"https://dualdiagnosis.org/marijana-treatment/bho-butane-toxicity/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Murray, R. M., Quigley, H., Quattrone, D., Englund, A., \u0026amp; Di Forti, M. (2016). Traditional marijuana, high‐potency cannabis and synthetic cannabinoids: increasing risk for psychosis.\u0026nbsp;\u003cem\u003eWorld Psychiatry\u003c/em\u003e,\u0026nbsp;\u003cem\u003e15\u003c/em\u003e(3), 195\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Stogner, J. M., \u0026amp; Miller, B. L. (2015). The dabbing dilemma: A call for research on butane hash oil and other alternate forms of cannabis use.\u0026nbsp;\u003cem\u003eSubstance abuse\u003c/em\u003e,\u0026nbsp;\u003cem\u003e36\u003c/em\u003e(4), 393\u0026ndash;395.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e McMahon, M. J., Bhatt, N. A., Stahlmann, C. G., \u0026amp; Philip, A. I. (2016). Severe Pneumonitis after Inhalation of Butane Hash Oil.\u0026nbsp;\u003cem\u003eAnnals of the American Thoracic Society\u003c/em\u003e,\u0026nbsp;\u003cem\u003e13\u003c/em\u003e(6), 991\u0026ndash;992. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1513/AnnalsATS.201602-101LE\u003c/span\u003e\u003cspan address=\"10.1513/AnnalsATS.201602-101LE\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M. W., Navon, L., Hoots, B., Salvatore, P. P., Elderbrook, M., Haupt, T., Kanne, J., Patel, M. T., Saathoff-Huber, L., King, B. A., Schier, J. G., Mikosz, C. A., \u0026amp; Meiman, J. (2020). Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report.\u0026nbsp;\u003cem\u003eThe New England journal of medicine\u003c/em\u003e,\u0026nbsp;\u003cem\u003e382\u003c/em\u003e(10), 903\u0026ndash;916. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa1911614\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1911614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Alzghari, S. K., Fung, V., Rickner, S. S., Chacko, L., \u0026amp; Fleming, S. W. (2017). To dab or not to dab: rising concerns regarding the toxicity of cannabis concentrates.\u0026nbsp;\u003cem\u003eCureus\u003c/em\u003e,\u0026nbsp;\u003cem\u003e9\u003c/em\u003e(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Berkowitz, E. A., Henry, T. S., Veeraraghavan, S., Staton, G. W., Jr, \u0026amp; Gal, A. A. (2015). Pulmonary effects of synthetic marijuana: chest radiography and CT findings.\u0026nbsp;\u003cem\u003eAJR. American journal of roentgenology\u003c/em\u003e,\u0026nbsp;\u003cem\u003e204\u003c/em\u003e(4), 750\u0026ndash;757. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2214/AJR.14.13138\u003c/span\u003e\u003cspan address=\"10.2214/AJR.14.13138\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Kokkarinen, J. I., Tukiainen, H. O., \u0026amp; Terho, E. O. (1992). Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung.\u0026nbsp;\u003cem\u003eThe American review of respiratory disease\u003c/em\u003e,\u0026nbsp;\u003cem\u003e145\u003c/em\u003e(1), 3\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1164/ajrccm/145.1.3\u003c/span\u003e\u003cspan address=\"10.1164/ajrccm/145.1.3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dabbing, Pneumonitis, Hypoxia, Tetrahydrocannabinol","lastPublishedDoi":"10.21203/rs.3.rs-4249247/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4249247/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eDabbing is recently getting popular in young adults. It is a new method of using the most active form of marijuana where large amount of concentrated tetrahydrocannabinol is inhaled. Tetrahydrocannabinol is associated with a feeling of ‘High’ which make the user feel joyous and relaxed. With increasing use of such technique, dabbing becomes an important differential for evaluation of acute respiratory failure with pneumonitis specially in adult population.\u003c/p\u003e\n\u003cp\u003eCase presentation\u003c/p\u003e\n\u003cp\u003eWe present a case report of 51 years old Caucasian male who presented to hospital with chest pressure and shortness of breath. Patient was noted to be hypoxic desaturating down to 82-83% on nasal cannula oxygen. Imaging revealed concern for multifocal pneumonia. Patient required use of high flow oxygen. Patient was started on broad spectrum antibiotics and intravenous corticosteroids. Patient had gradual improvement in his symptoms and was able to come off oxygen completely. Patient was discharged home on prednisone taper.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eDabbing is a newer technique which has been gaining popularity for marijuana usage. With legalization of marijuana newer techniques are getting popular. Our case report emphasizes the importance of keeping dabbing as a differential when patient presents with respiratory failure and has concerns for pneumonitis. Patients might not reveal until specifically asked about their practices.\u003c/p\u003e","manuscriptTitle":"Hot Dab Associated Pneumonitis - A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-25 16:45:38","doi":"10.21203/rs.3.rs-4249247/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-18T18:18:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-15T20:54:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T16:07:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-08T01:05:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325673468292663817368802130839304070658","date":"2024-07-07T14:16:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222341774663548545526272576053500797590","date":"2024-07-05T16:23:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151321315139607948726762247884120271102","date":"2024-07-03T09:18:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-02T06:40:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243030159214198746887494262788113263297","date":"2024-07-02T05:44:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-26T00:06:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-19T17:05:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-18T03:08:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-18T03:06:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2024-04-10T21:17:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99b09c92-a11b-4b62-8990-01841ec4b9c1","owner":[],"postedDate":"April 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:01:21+00:00","versionOfRecord":{"articleIdentity":"rs-4249247","link":"https://doi.org/10.1186/s12890-024-03255-8","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2024-09-13 15:57:26","publishedOnDateReadable":"September 13th, 2024"},"versionCreatedAt":"2024-04-25 16:45:38","video":"","vorDoi":"10.1186/s12890-024-03255-8","vorDoiUrl":"https://doi.org/10.1186/s12890-024-03255-8","workflowStages":[]},"version":"v1","identity":"rs-4249247","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4249247","identity":"rs-4249247","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}