Lung injury associated with electronic cigarettes inhalation diagnosed by transbronchial lung biopsy

Abstract

A 46‐year‐old healthy man developed respiratory distress, night sweats, fever, and weight loss after using electronic cigarettes (e‐cigs) for approximately 1 month. He presented to the hospital when the symptoms worsened 2 months after onset. The findings of bronchoalveolar lavage (BAL) fluid examination and the following transbronchial lung biopsy examination led to the diagnosis of acute alveolitis: intra‐alveolar fibrosis accompanied with exudate containing abundant lipid‐laden macrophages, eosinophils, and neutrophils. Eventually, e‐cig–induced acute lung injury was diagnosed. The symptoms were rapidly alleviated upon e‐cig use termination and methylprednisolone pulse therapy, and no subsequent recurrence was observed. There have been only a few reported cases of e‐cig–induced lung injury. In e‐cig users presenting with atypical pneumonia, close examination by BAL and biopsy should be performed to verify the presence or absence of lipid‐laden macrophages.

Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine

“…Multiple case reports have described atypical types of pneumonia in ENDS users (15,16). A shared feature in these reports is the presence of lipid-laden macrophages found in the bronchoalveolar lavage (BAL) fluid from individuals with ENDS-associated pneumonia (15,16). Despite this commonality, the physiological importance of lipid accumulation and whether this phenomenon can be recapitulated in experimental systems remain unknown.…”

VpALI—Vaping-related Acute Lung Injury: A New Killer Around the Block

“…Hypoxemia is a constant, and respiratory symptoms usually include nonproductive cough and shortness of breath; however, initial constitutional symptoms were also mentioned. 71,72 Interestingly, cases related to the inhalation of cannabis have been reported with overall similar factors and findings. In contrast to traditional vaping cases, hemoptysis was more frequently reported in cannabis users.…”

Immunological and pathological effects of electronic cigarettes

“…He was found to have BALF that contained abundant lipid‐laden macrophages, eosinophils and neutrophils. The symptoms were fully abolished after E‐cigarette abstinence . These clinical cases illustrate that E‐cigarettes can have a negative impact on respiratory health.…”

“…The symptoms were fully abolished after E-cigarette abstinence. 105 These clinical cases illustrate that E-cigarettes can have a negative impact on respiratory health. Respiratory epithelium is a ciliated epithelium forming the integral barrier against inhaled agents to prevent infection and injury by trapping and expelling particles (mucociliary clearance), phagocytosing and killing pathogens and recruiting immune cells.…”