An Unusual Complication of Electronic Cigarette Use: Missed Inhaled Foreign Body Causing Acute Respiratory Failure

We present a case of a young woman who was admitted to the hospital with persistent pneumonia and cough productive of purulent green sputum. She was admitted to the intensive care unit due to type 1 respiratory failure. Chest computerised tomography (CT) showed a large right-sided hydropneumothorax, for which a right-sided chest drain was inserted. Despite intubation, oxygenation continued to deteriorate and the patient was commenced on veno-venous extracorporeal membrane oxygenation (ECMO) and transferred to the regional ECMO centre. Bronchoscopy revealed a plastic coil from an electronic cigarette at the entrance to the right lower lobe. Following its removal, the patient's condition rapidly improved and she was successfully weaned from ECMO and discharged from the cardiothoracic critical care unit. There are very few reports of tracheobronchial foreign body (FB) aspiration secondary to electronic cigarette use, and tracheobronchial FB aspiration in adults requiring veno-venous ECMO to treat respiratory failure is uncommon. This case highlights the importance of considering tracheobronchial FB aspiration as a potential diagnosis in patients who present with more than two weeks of pneumonia not responding to treatment.