E-Cigarette– or Vaping-Associated Lung Injury ( 1 фото )

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A 27-year-old man with a long history of asthma presented to the emergency department with a 5-day history of fever, vomiting, diarrhea, dyspnea, and hemoptysis. One year before presentation, he had switched from smoking tobacco cigarettes to vaping. He also worked at an e-cigarette store, where he was exposed to second-hand e-cigarette vapors. The respiratory rate was 44 breaths per minute, and the oxygen saturation 83% while the patient was breathing ambient air. On physical examination, crackles were noted in both lungs. Endotracheal intubation was performed. A chest radiograph showed patchy consolidations on both sides (Panel A). Computed tomography of the chest revealed consolidations and ground-glass opacities in both lungs, with sparing of the subpleural areas (Panel B), as well as pleural effusions on both sides, with a greater amount of fluid on the right than on the left (Panel C). Testing of serum and bronchoalveolar lavage (BAL) fluid was negative for infectious diseases and rheumatologic conditions. BAL fluid testing for vitamin E acetate and tetrahydrocannabinol — two substances in vaping oils that are associated with lung injury — was not available. A diagnosis of e-cigarette– or vaping-associated lung injury was made. Treatment with a 4-week tapering course of systemic glucocorticoids was initiated. The patient was extubated after 1 month, and he was discharged with no need for oxygen supplementation.
Mohd Zulkimi Roslly, M.D. and Syarifah A.A. Syed Rozhan, M.B., B.Ch.
Published August 2, 2025
N Engl J Med 2025;393:592
DOI: 10.1056/NEJMicm2503172
VOL. 393 NO. 6

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