Electronic cigarette use as a rare cause of diffuse alveolar hemorrhage

The increasing use of electronic cigarettes (e-cigarettes) among young adults has led to the emergence of electronic cigarette or vaping-associated lung injury (EVALI), which includes a wide spectrum of pulmonary complications. Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening manifestation of EVALI. We aim to present a fatal case of DAH in a previously healthy young adult following recent e-cigarette use. A 23-year-old Turkish male with no prior medical history presented with dyspnea, cough, and hemoptysis 2 days after initiating frequent e-cigarette use. He had no history of chronic illness, substance use, or allergies. On admission, he was hypoxic with bilateral rales and diffuse ground-glass opacities on chest computed tomography (CT). Laboratory tests revealed severe anemia, leukocytosis, and elevated inflammatory markers. Despite treatment with high-dose corticosteroids, tranexamic acid, antibiotics, and supportive therapy, the patient's condition deteriorated, and he died on the 7^th day of hospitalization. E-cigarette use has been increasingly associated with severe lung injuries, including DAH. The exact pathophysiology remains unclear but may involve direct alveolar epithelial damage and inflammatory responses. Our case is consistent with previously reported cases of vaping-induced DAH and highlights the potential severity of this condition. E-cigarettes are not a safe alternative to traditional tobacco. Clinicians should maintain a high index of suspicion for DAH in patients presenting with hemoptysis and respiratory failure following vaping. Early recognition and aggressive management are critical to improve outcomes.