Electronic cigarette (e-cigarette) use, or vaping, is gaining widespread popularity among adults aged 18–35. Vaping is commercially promoted as a safer alternative to traditional cigarette smoking. Previous studies have reported a close relationship between conventional cigarette smoking and acute eosinophilic pneumonia (AEP), but only one case report to date associates vaping with AEP in a male patient. We present the first case of AEP involving a young female after use of e-cigarettes. Clinicians should consider AEP when evaluating young patients with hypoxic respiratory failure and a recent history of e-cigarette use. This case highlights the need for more research into the relationship between e-cigarettes and AEP.

Armored scale insects pose a serious threat to habitat conservation across the globe because they include some of the most potent invasive species in the world. They are such a serious concern because their basic morphology, small size, and polyphagous feeding habits often allow them to exist undetected by growers and quarantine experts. In order to provide a potential solution to the problem, we have attempted to elucidate the effectiveness of molecular identification techniques using ribosomal 28s and endosymbiotic 16s rRNA. Sequence data was obtained from many field-collected insects to test the feasibility of identification techniques. A protocol for quick species determination based on sequence data is provided.

A 71-year-old man with a history of asthma and gastroesophageal reflux disease (GERD) presented to the emergency department (ED) with a chief complaint of new-onset right-sided abdominal tenderness attributed to chronic cough. Over the past 2 months, he had been treated with a proton pump inhibitor, leukotriene antagonist, and inhaled steroid without improvement. He also endorsed a 14-pound weight loss.On presentation to the ED, laboratory test results were significant for a new elevation in liver-associated enzymes (aspartate transaminase 60 U/L and alanine transaminase 85 U/L), prompting right-upper quadrant ultrasound evaluation. The ultrasound revealed innumerable solid lesions within the liver, and a subsequent thoracic, abdominal, and pelvic computed tomography showed a 1.9-cm 3 6.1-cm mass within the distal esophagus. The patient was admitted for expedited workup of suspected malignancy.An esophagogastroduodenoscopy (EGD) was performed which revealed a pigmented mass in the distal esophagus (Figure 1). The lesion had a vascular appearance, so biopsies were taken from the periphery of the mass and opposite wall; these demonstrated melanocytic proliferation but did not establish the diagnosis of malignant melanoma (Figure 2). Interventional radiology-guided biopsies of the liver confirmed the diagnosis of metastatic malignant melanoma. The patient was diagnosed with T4bN3M1a BRAF-negative metastatic melanoma involving the esophagus, liver, mesentery, and lumbar spine. Detailed skin examination and formal ophthalmology evaluation did not reveal any primary lesions, establishing the diagnosis of primary malignant melanoma of the esophagus (PMME).Given his metastatic disease burden, radical esophagectomy, the standard treatment for PMME, could not be performed. He was treated with 1 cycle of dual checkpoint inhibitor therapy with ipilimumab and nivolumab, a CTLA-4 and PD-1 inhibitor. The treatment course was complicated by autoimmune hepatitis. The patient declined additional chemotherapy, and he transitioned to comfort care. Figure 1. (A and B): Hyperpigmented mass in the distal esophagus from esophagogastroduodenoscopy.

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