Acute grade IV toxic hepatitis due to the e-cigarette

Area of Science:

• Hepatology
• Toxicology
• Pulmonology

Background:

• Drug-induced liver disease (DILI) is a significant cause of acute liver injury.
• E-cigarettes and vaping products are increasingly popular, but their potential health effects, particularly on the liver, are not fully understood.

Observation:

• A 46-year-old woman experienced recurrent acute hepatitis with jaundice.
• Extensive work-up, including liver biopsy, initially suspected DILI.
• The patient recovered after initial treatment but relapsed a year later with similar symptoms.

Findings:

• Vaping was identified as the sole causative agent for the recurrent DILI.
• Discontinuation of vaping led to complete resolution of the hepatitis.
• A high RUCAM score (10) supported the diagnosis of toxic hepatitis.

Implications:

• This case highlights severe DILI secondary to e-cigarette use, a novel finding.
• Vaping should be considered in the differential diagnosis for patients presenting with acute hepatitis of unknown etiology.
• Further research is warranted to understand the hepatotoxic potential of vaping constituents.