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A3565 - The Dark Side of Vaping; Acute Dyspnea and Granulomatous Lung Disease Associated with Electronic Cigarettes
Author Block: N. Poponea, E. Shehada, N. Freeman; Pulmonary and Critical Care Medicine, Mclaren Oakland Hospital, Pontiac, MI, United States.
Introduction: In recent years, the usage of electronic cigarettes (e-cigarettes) has skyrocketed. They’re perceived by many as a less harmful alternative to traditional cigarettes, however, mounting evidence suggests that e-cigarettes may not be as safe as popular opinion suggest. In light of this, we present the case of a 43 year old patient who developed acute dyspnea after substituting traditional smoking with e-cigarettes.
Case: A 43 year old male with a past medical history significant for pulmonary embolism and asthma presented to a community emergency department (ED) with 7 days of worsening dyspnea and chest tightness. He admitted to smoking one pack/day for nearly twenty years, but stated that he had ceased traditional smoking seven days prior and instead had been using e-cigarettes. This is approximately the time when he first noticed his symptoms. In the ED, the patient had a computed tomographic angiogram (CTA) scan of his chest, which showed no evidence of acute pulmonary embolism, but did reveal multiple small, bilateral, pulmonary nodules. These lesions were not noted to be present on a CT scan performed one year prior. During his hospital stay, the patient underwent fiberoptic bronchoscopy with transbronchial biopsy of the right upper lobe, which revealed epithelioid noncaseating granulomas. The patient was subsequently started on a 60 mg oral prednisone taper for a duration of six months and was instructed to abstain from e-cigarettes. Upon presenting for an office follow-up visit four months later, the patient’s initial complaints had resolved and a repeat CT scan showed complete resolution of the aforementioned nodules.
Discussion: The contents of e-cigarette vapor include a litany of substances, some of which have been well established causes of diffuse parenchymal lung disease. One such substance in particular - flavoring agents known as diacetyl compounds - appear to be the most egregious offenders. Numerous reports exist in the medical literature implicating diacetyl compounds as the likely etiology for cases of interstitial and inflammatory lung diseases. In our patient’s case, he had biopsy-proven granulomatous lung disease, which we suspect arose from his usage of e-cigarettes and resolved after abstaining from them. This temporal association supports the contention that e-cigarette vapor was the most likely cause of this patient’s condition. Given the growing popularity of e-cigarettes, further investigations should be undertaken to study the potential ill-effects of the many substances found in their vapor and, if necessary, to promote their regulation.