Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes

Abstract

A young female vaper presented with insidious onset cough, progressive dyspnoea on exertion, fever, night sweats and was in respiratory failure when admitted to hospital. Clinical examination was unremarkable. Haematological tests revealed only thrombocytopenia, which was long standing, and her biochemical and inflammatory markers were normal. Chest radiograph and high-resolution CT showed diffuse ground-glass infiltrates with reticulation. She was initially treated with empirical steroids and there was improvement in her oxygenation, which facilitated further tests. Since the bronchoscopy and high-volume lavage was unyielding, a video-assisted thoracoscopicsurgical biopsy was done later and was suggestive of lipoid pneumonia. The only source of lipid was the vegetable glycerine found in e-cigarette (EC). Despite our advice to quit vaping, she continued to use EC with different flavours and there is not much improvement in her clinical and spirometric parameters.

Keywords: interstitial lung disease; pneumonia (respiratory medicine).

Figure 1

(A) Chest radiograph showing bilateral diffuse infiltrates throughout both lung fields. (B) High-resolution CT slice from upper lobes showing diffuse ground-glass opacity and subpleural cysts bilaterally.

Figure 2

Cytology from the bronchoalveolar lavage showing an occasional alveolar macrophage with foamy cytoplasm (arrowed) consistent with phagocytosis of lipid material.

Figure 3

Low-power view showing uninvolved lung at 11 o’clock but a large central area of consolidation.

Figure 4

Lung biopsy (original magnification ×40) showing cholesterol clefts within the airspaces, adjacent to normal-looking bronchiole and pulmonary artery.