Since their marketing in the US in 2007, e-cigarettes or vaping products are considered an alternative for patients who would like to quit smoking. More teenagers have been using e-cigarettes recreationally and e-cigarette or vaping associated lung injury (EVALI) has been reported in an increasing number, especially related to either aerosolized vitamin-E product or tetrahydrocannabinol (THC). EVALI has been described with multiple clinical presentations, the most common being acute respiratory distress syndrome (ARDS)-like picture, including over 2,000 of related deaths nationwide as of January of 2020, without established pathophysiology. There's no case report to date demonstrating e-cigarette use associated with lung abscess. CASE PRESENTATION: We present a case of a 21-year-old white male with past medical history of anxiety and depression who presented with a 3-week history of fatigue, weakness, progressive cough productive of dark gray sputum, and pleuritic chest pain. He had preceding fever, night sweats and had been having nausea, vomiting, diarrhea, and significant weight loss. He denied swallowing dificulty or risks of aspiration. His only medication was fluoxetine. He vaped 1 Jule pod every week for the past 2 years, but denied alcohol use or use of any other illicit drugs. His initial vital signs were within normal limits. He had no fever and his oxygenation on room air was normal. His physical exam revealed a cachectic individual without cyanosis. His lung exam was unremarkable. His initial labs were significant for leukocytosis with left shift, elevated ESR, CRP, and mild hyponatremia. His CXR revealed a cavity-like lesion around his right hilar area, confirmed to be lung abscess by non-contrast chest CT. There was reactive adenopathy.He was then managed conservatively with IV ampicillin-sulbactam, to which he responded clinically, and later was sent home on PO amoxicillin-clavulanate to finish a 6-week course of antibiotics. He committed to completely quit vaping after admission. Upon follow up, he continued to improve clinically and his repeat CXR showed complete resolution of his mass-like lesion resolved 3 weeks after discharge. DISCUSSION: E-cigarette smoking or vaping is now considered to be one of the emerging health outbreaks in the US, with increasing numbers identified by CDC, FDA, and state health authorities. CDC recommends that if e-cigarettes and vaping is suspected as a possible etiology for a patient's pulmonary disease, a detailed history of the substances used, the sources, and the devices used should be obtained, and efforts should be made to determine if any remaining product, devices, or liquids are available for testing. The majority of cases reported have been lung injury sometimes associated with life-threatening hypoxemia.
