Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping)

A Report of Eight Cases

Sanjay Mukhopadhyay, MD; Mitra Mehrad, MD; Pedro Dammert, MD; Andrea V. Arrossi, MD; Rakesh Sarda, MD; David S. Brenner, MD; Fabien Maldonado, MD; Humberto Choi, MD; Michael Ghobrial, MD


Am J Clin Pathol. 2019;153(1):30-39. 

In This Article

Materials and Methods

Eight patients with vaping-associated pulmonary illness who underwent lung biopsies at five separate institutions form the basis of this report (seven transbronchial lung biopsies and one surgical lung biopsy). Cases were included if they fulfilled the CDC surveillance case definition for severe pulmonary disease associated with e-cigarette use.[4] All but one case in this series fulfilled CDC criteria for a "confirmed case," which are as follows:

  1. Using an e-cigarette or dabbing during the 90 days before symptom onset

  2. Pulmonary infiltrate on chest radiograph or ground-glass opacities on chest computed tomography (CT)

  3. Absence of pulmonary infection on initial workup. Minimum criteria include negative respiratory viral panel, influenza polymerase chain reaction, or rapid test if local epidemiology supports testing. All other clinically indicated respiratory infectious disease testing (eg, urine antigen for Streptococcus pneumoniae and Legionella, sputum culture if productive cough, BAL culture if done, blood culture, human immunodeficiency virus (HIV)–related opportunistic respiratory infections if appropriate) must be negative.

  4. No evidence in medical record of alternative plausible diagnoses (eg, cardiac, rheumatologic, or neoplastic process)

CDC criteria for a "probable case" differ from confirmed cases only in that infection may be identified via culture or polymerase chain reaction, but the clinical team believes this is not the sole cause of the underlying respiratory disease process. One case in this report fulfilled criteria for a probable case (case 4).