E-cigarette or vaping product use-associated lung injury presenting with probable diffuse alveolar haemorrhage: A case report

English:

E-cigarette or vaping product use–associated lung injury (EVALI) is an increasingly recognised cause of acute respiratory illness in young adults. While most cases present with acute lung injury or organising pneumonia, diffuse alveolar haemorrhage (DAH) is a rare and severe manifestation. A 24-year-old previously healthy male presented with fever and malaise following recent heavy vaping, which rapidly progressed to severe breathlessness. His clinical condition worsened rapidly, with severe hypoxaemia, haemodynamic instability and an acute fall in haemoglobin. High-resolution computed tomography showed diffuse ground-glass opacities and consolidation. Bronchoscopy demonstrated fresh blood within the segmental airways of both lower lobes. Investigations for infectious, autoimmune and vasculitic causes were negative. In the context of recent vaping exposure and exclusion of alternative diagnoses, EVALI presenting with probable DAH was considered. The patient was managed with supportive care, mechanical ventilation, antibiotics and systemic corticosteroids, resulting in gradual clinical and radiologic improvement. This case underscores the importance of obtaining a detailed vaping history despite the inability to perform sequential BAL. DAH is an uncommon but life-threatening presentation of EVALI, and a high index of suspicion is required in young patients with acute respiratory failure, falling haemoglobin and diffuse infiltrates, as early recognition and supportive management can be life-saving.