A team led by the Nottingham University Hospitals has reported a case of hypersensitivity pneumonitis (HP) secondary to vaping.
According to the case report published in the Archives of Disease in Childhood, the previously healthy 16-year-old presented to the emergency department with a seven-day history of fever, cough and increasing difficulty breathing despite oral antibiotics and inhaled salbutamol. There was no previous confirmed diagnosis of asthma.
He deteriorated rapidly and required non-invasive, conventional and then high-frequency oscillation ventilation and was finally transferred for extracorporeal membrane oxygenation (ECMO) because of intractable respiratory failure. He received three days of venovenous ECMO with broad spectrum intravenous antibiotics, hydrocortisone, macrolide and antifungals. He developed a critical illness and steroid myopathy and required prolonged rehabilitation.
A chest computed tomography six days after admission showed bilateral ground glass changes in the upper and mid zones, with perihilar bronchial wall thickening and retained secretions in the dependant airways. Bronchoalveolar lavage and a later expectorated sputum sample showed moderate numbers of macrophages, neutrophils and eosinophils consistent with active inflammation. Spirometry 22 days after admission showed forced expiratory volume in one second of 3.52 L (z score, −1.91) and forced vital capacity of 3.68 L (z score, −2.73).
A surgical lung biopsy was obtained 50 days after his first presentation as he continued to be symptomatic. The biopsy showed alveolar spaces containing macrophages and evidence of haemorrhage.
Fourteen months after initial presentation, he was asymptomatic with normal spirometry.
The authors advise that a reaction to e-cigarettes should always be considered in a patient presenting with atypical respiratory illness.
They warn that “we consider e-cigarettes as ‘much safer than tobacco’ at our peril."
