Life threatening lung inflammation triggered by e-cig fluid reaction

Public health

By Nicola Garrett

12 Nov 2019

Clinicians should consider a potential allergic reaction to e-cigarettes in someone presenting with an atypical respiratory illness, doctors advise. 

In a case study published in the Archives of Disease in Childhood, Dr Jayesh Mahendra Bhatt, a paediatric respiratory physician at Nottingham University Hospital, UK and colleagues detail the case of a 16-year-old boy diagnosed with hypersensitivity pneumonitis linked to vaping. 

The patient presented to the emergency department with a week-long history of fever, cough and increasing difficulty breathing despite taking antibiotics and inhaled salbutamol. 

Upon admission, his condition deteriorated rapidly and intractable respiratory failure meant that he eventually needed ECMO. Following further treatment, he developed a critical illness, steroid myopathy and required prolonged rehabilitation.

The patient revealed that he had recently started vaping two different types of e-cigarette liquid. The listed ingredients for both vaping liquids were the same apart from the unnamed flavourings.

He had not been in contact with farm animals, birds or recently travelled overseas and had not recently smoked cannabis. 

Lung scans and biopsy samples were consistent with hypersensitivity pneumonitis. The patient was eventually discharged 35 days after admission but he still had symptoms and remained on steroids.

An in-house ELISA developed to detect antibodies specific to the e-cigarette liquids showed that the patient had more antibodies to one of the two e-cigarette liquids.

“We detected serum IgM antibodies against the implicated liquid raising the possibility that the eliciting antigen was present in the vaping liquid,” the authors wrote. 

After 14 months the patient was asymptomatic and had normal spirometry. According to the authors the case study highlighted two important lessons. 

“The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as ‘much safer than tobacco’ at our peril.”

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