E-cigarette/vaping associated lung injury: an ongoing public health crisis

E-cigarette or vaping-associated lung injury (EVALI) remains an important but often overlooked cause of acute respiratory failure, particularly in the years following the COVID-19 pandemic. We describe a middle-aged woman with a recent history of nicotine-only vaping who presented with worsening cough, dyspnoea on exertion and progressive hypoxia. Imaging initially suggested multifocal pneumonia, and she was started on broad-spectrum antibiotics and bronchodilator therapy. Despite this, she continued to deteriorate, prompting intensive care unit transfer and initiation of high-dose corticosteroids. Extensive workup including infectious, autoimmune and vasculitis panels was negative. Given her history of recent vaping, EVALI was considered the most likely aetiology. Her clinical course improved significantly after corticosteroid therapy, and she was discharged on a steroid taper. This case highlights the diagnostic challenges posed by EVALI and the ongoing risk associated with vaping, including those containing only nicotine. This case report aims to contribute to the ongoing clinical awareness of EVALI.