title: Respiratory bronchiolitis-associated interstitial lung disease secondary to electronic nicotine delivery system use confirmed with open lung biopsy.
abstract: As a modern phenomenon, there is currently limited understanding of the possible toxic effects and broader implications of electronic nicotine delivery systems (ENDS). Large volumes of aerosolized particles are inhaled during "vaping" and there are now an increasing number of case reports demonstrating toxic effects of ENDS, as well as human studies demonstrating impaired lung function in users. This article presents a case of respiratory bronchiolitis interstitial lung disease (RB-ILD) precipitated by vaping in a 33-year-old male with 10 pack years of traditional cigarette and prior treatment for mixed germ cell tumour. The patient had started vaping 10-15 times per day while continuing to smoke 10 traditional cigarettes per day. After 3 months of exposure to e-cigarette vapour, chest computed tomography demonstrated multiple new poorly defined pulmonary nodules with fluffy parenchyma opacification centred along the terminal bronchovascular units. Video-assisted thoracoscopy with lung biopsy of the right upper and right middle lobes was undertaken. The microscopic findings were overall consistent with RB-ILD. This case demonstrates toxicity with use of ENDS on open lung biopsy with resolution of radiographic findings on cessation. We believe that this is the first case where open lung biopsy has demonstrated this and our findings are consistent with RB-ILD.
authors.affiliation: Department of Thoracic Medicine Royal Brisbane and Women's Hospital Herston QLD Australia; School of Medicine University of Queensland Brisbane Australia.
authors.forename: Mark
authors.identifier: 0000-0002-0983-2095
authors.initials: M
authors.lastname: Flower
authors.affiliation: Department of Pathology Royal Brisbane and Women's Hospital Herston QLD Australia.
authors.forename: Lakshmy
authors.initials: L
authors.lastname: Nandakumar
authors.affiliation: Department of Pathology Royal Brisbane and Women's Hospital Herston QLD Australia.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Medical Oncology Royal Brisbane and Women's Hospital Herston QLD Australia.
authors.forename: David
authors.initials: D
authors.lastname: Wyld
authors.affiliation: Department of Thoracic Surgery Royal Brisbane and Women's Hospital Herston QLD Australia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Windsor
authors.affiliation: Department of Thoracic Medicine Royal Brisbane and Women's Hospital Herston QLD Australia; School of Medicine University of Queensland Brisbane Australia.
authors.forename: David
authors.initials: D
authors.lastname: Fielding
keywords: Electronic nicotine delivery systems; RB‐ILD; interstitial lung disease; lung injury; thoracic surgery