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Respirol Case Rep. 2017 Nov 17;6(1):e00282. doi: 10.1002/rcr2.282. eCollection 2018 Jan.

Lung injury associated with electronic cigarettes inhalation diagnosed by transbronchial lung biopsy.

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Department of Respiratory Medicine Kashiwa Tanaka Hospital Chiba Japan.
Department of Respiratory Medicine Tokyo Medical University Ibaraki Medical Center Ibaraki Japan.
Department of Pathology Japanese Red Cross Medical Center Tokyo Japan.


A 46-year-old healthy man developed respiratory distress, night sweats, fever, and weight loss after using electronic cigarettes (e-cigs) for approximately 1 month. He presented to the hospital when the symptoms worsened 2 months after onset. The findings of bronchoalveolar lavage (BAL) fluid examination and the following transbronchial lung biopsy examination led to the diagnosis of acute alveolitis: intra-alveolar fibrosis accompanied with exudate containing abundant lipid-laden macrophages, eosinophils, and neutrophils. Eventually, e-cig-induced acute lung injury was diagnosed. The symptoms were rapidly alleviated upon e-cig use termination and methylprednisolone pulse therapy, and no subsequent recurrence was observed. There have been only a few reported cases of e-cig-induced lung injury. In e-cig users presenting with atypical pneumonia, close examination by BAL and biopsy should be performed to verify the presence or absence of lipid-laden macrophages.


Acute lung injury; bronchoalveolar lavage; electronic cigarette; lipid‐laden macrophages; transbronchial lung biopsy

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