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Life-threatening hypersensitivity pneumonitis secondary to e-cigarettes
  1. Nisha Nair1,
  2. Matthew Hurley2,
  3. Simon Gates1,
  4. Patrick Davies3,
  5. I-Ling Chen4,
  6. Ian Todd4,
  7. Lucy Fairclough4,
  8. Andrew Bush5,
  9. Jayesh Mahendra Bhatt2
  1. 1 Paediatric Therapy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 Department of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 Department of Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4 Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  5. 5 Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jayesh Mahendra Bhatt, Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; jayesh.bhatt{at}


We report a case of hypersensitivity pneumonitis (HP) in a young person secondary to vaping. He presented with a putative diagnosis of asthma and required extracorporeal membrane oxygenation

because of intractable respiratory failure. He developed a critical illness and steroid myopathy and required prolonged rehabilitation. Our patient fulfils diagnostic criteria for HP secondary to e-cigarettes with a positive exposure history, deterioration after skin prick testing, specific serum IgM antibodies against the implicated liquid raising the possibility that the relevant antigen was present in that liquid and radiological and histopathological features compatible with acute HP. There are two learning points. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as ‘much safer than tobacco’ at our peril.

  • hypersensitivity pneumonitis
  • e-cigarettes
  • respiratory failure
  • vaping
  • enzyme-linked immunosorbent assay (ELISA)
  • tobacco

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  • Contributors NN: reviewed case notes and wrote parts of case (as indicated). MH, SG and PD: contributed to clinical management. LF and IT; consultant immunologists supervised I-LC to develop the immunologic assay and wrote part of the case (as indicated). AB: professor of paediatric respirology reviewed drafts and suggested major improvements and agreed on the final draft. JMB: consultant respiratory paediatrician in charge of the patient’s respiratory care, suggested writing case report for this patient, collated contributions from the other authors, obtained images, obtained informed consent from the patient, wrote substantial parts of case (as indicated), reviewed drafts and suggested improvements and agreed on the final draft and is the corresponding author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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