Abstract
The use of electronic cigarettes or vaping, has become
increasingly common among adolescents and young adults, often mistakenly
considered a safe alternative to conventional smoking. However, recent studies
have shown an association between vaping and the development of severe lung
injuries, including bronchopneumonia. This report describes the case of a
previously healthy 20-year-old female patient who developed bronchopneumonia
associated with the use of electronic cigarettes. The patient presented with fever,
dyspnea, chest pain and a syncope episode. A chest X-ray revealed consolidation
in the right hemithorax. Laboratory tests showed hypokalemia, which was
corrected during hospitalization. Antibiotic therapy with ceftriaxone and
azithromycin was initiated, resulting in significant clinical improvement
without the need for mechanical ventilation or intensive care unit admission.
This case highlights the importance of early recognition of clinical and
laboratory signs associated with vaping-induced pulmonary toxicity and the need
for preventive campaigns on the respiratory risks of these substances.
Outpatient follow-up with a multidisciplinary team is essential for full
recovery and prevention of recurrence.
Keywords: Bronchopneumonia; Vaping; Hypokalemia;
Electronic cigarette; Case report
Introduction
Bronchopneumonia is a form of bacterial pneumonia
characterized by acute, multifocal inflammation of the terminal bronchioles and
pulmonary alveoli, resulting in scattered consolidations throughout the lungs.
Traditionally, it is associated with predisposing factors such as
immunosuppression, prior viral infections, smoking and chronic comorbidities.
However, with the emergence of new inhalation devices like electronic
cigarettes, a new epidemiological profile of patients with respiratory
illnesses has emerged, particularly among adolescents and young adults. Vaping
is marketed as a less harmful alternative to traditional tobacco; however, the
aerosols produced by electronic devices contain various chemical compounds,
including propylene glycol, glycerin, nicotine and often tetrahydrocannabinol
(THC) and vitamin E acetate. These elements can trigger inflammatory processes
and direct injury to the respiratory epithelium, leading to clinical conditions
such as bronchopneumonia, lipoid pneumonitis and EVALI (E-cigarette or Vaping
product use-Associated Lung Injury).
Additionally, electrolyte imbalances such as
hypokalemia have been described in patients with acute respiratory conditions,
especially in the presence of prolonged fever, vomiting, diuretic use or
dietary changes. Hypokalemia may contribute to respiratory muscle weakness,
worsening the clinical scenario and increasing the risk of respiratory failure.
In this context, comprehensive assessment of young patients presenting with
acute respiratory symptoms is essential, even in the absence of prior comorbidities.
The association between vaping and lung injury should always be considered and
management should include not only infection treatment but also correction of
potential metabolic disturbances and strong counseling for permanent cessation
of electronic cigarette use.
Objectives
This study aims to report a clinical case of
bronchopneumonia in a previously healthy young patient with associated
hypokalaemia, in which electronic cigarette use was the likely etiological
factor, contributing to the discussion on the respiratory risks of vaping in
young populations.
Study Design and Methods
This is a retrospective case report based on
electronic medical records, supplemented by a brief literature review.
Case Report
A 20-year-old female patient, previously healthy, was
admitted on 05/03/2024 with fever, dyspnea, chest pain and a syncope episode
after five days of respiratory symptoms. A chest X-ray revealed
bronchopneumonia with consolidation in the right hemithorax. The patient had
associated hypokalemia. She denied any comorbidities but reported the use of
electronic cigarettes. Physical examination revealed decreased vesicular breath
sounds and crackles at the right lung base; vital signs and neurological examination
were within normal limits. Arterial blood gas and electrolytes confirmed
hypokalemia, which was corrected during hospitalization. Antibiotic therapy
with ceftriaxone (2 g/day for 7 days) and azithromycin (500 mg/day for 5 days)
was initiated, with a good clinical response. The patient showed progressive
improvement, maintaining a productive cough but without fever or signs of
respiratory worsening. Mechanical ventilation or ICU admission was not
necessary. After clinical stabilization, she was discharged with a prescription
for home inhalation therapy and outpatient follow-up at the Primary Health Unit
(PHU) and with a pulmonologist. A medical certificate and instructions for
returning in case of clinical deterioration were also provided.
Conclusion
This case reinforces the growing concern within the
medical and scientific community regarding the harmful effects of electronic
cigarettes on lung health, particularly among young people. Bronchopneumonia
associated with vaping, although still underreported, represents a clinical
entity with potential for rapid deterioration, especially when accompanied by
metabolic disturbances such as hypokalaemia. The favourable clinical outcome
observed in this patient demonstrates the importance of early intervention,
including prompt initiation of broad-spectrum antibiotics and appropriate
electrolyte replacement. The absence of comorbidities and the young age were
protective factors that allowed recovery without the need for ventilatory
support or intensive care.
However, it is crucial to emphasize that the same
condition could take a more severe course in individuals with additional risk
factors. Beyond clinical treatment, a robust preventive approach is needed. The
lack of awareness about the adverse effects of vaping, combined with widespread
commercial promotion of these devices, contributes to their trivialization
among youth. Therefore, the implementation of educational initiatives in
schools, universities and health services is essential to raise awareness about
the risks associated with vaping. Clinically, this report highlights the
importance of including electronic cigarette use in the anamnesis of young
patients presenting with acute respiratory diseases. Careful evaluation of
radiological, laboratory and clinical signs should guide differential
diagnosis, with vaping-associated bronchopneumonia being a possibility that
deserves greater recognition. Lastly, outpatient follow-up after hospital
discharge is essential. Pulmonary recovery can be slow and cessation of smoking
even in its electronic form must be strongly reinforced with the support of a
multidisciplinary team, including pulmonologists, general practitioners,
psychologists and primary care professionals. Cases like this demonstrate that
although vaping is often perceived as harmless, it can trigger serious and
potentially fatal consequences, requiring a vigilant, critical and preventive
stance from healthcare professionals.
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