Vaping Associated Pulmonary Injury (VAPI) with superimposed Mycoplasma pneumoniae infection

There is growing evidence that vaping has the potential to cause adverse health effects. Vaping is affecting the younger and healthier population which is a public concern. Mycoplasma pneumoniae pneumonia is a benign condition and is usually underdiagnosed and is managed in an outpatient setting. Here we present a case of fulminant MPP in a young adult probably associated with VAPI. A 24-year-old woman presented to our hospital for severe hypoxic respiratory failure needing intubation and intensive care unit admission. She had a history for vaping for 2 years prior to presentation. She had fever and an elevated white count. Her Chest X-Ray and CT scan of the chest were consistent with bilateral predominantly lower lobe patchy opacities. She had mildly elevated serum LDH and Urine toxicology screen was positive for THC. Serum IgM Mycoplasma level was positive and her BAL fluid analysis showed lipid-laden macrophages. She was diagnosed as a probable case of VAPI per CDC guidelines with superimposed fulminant MPP. Vaping is known to increase the risk of viral and bacterial pneumonia by compromising the respiratory local immune response. Vaping also causes lipoid pneumonia where the alveoli are filled with lipid-laden macrophages with surrounding inflammation. We hypothesize that this patient had fulminant MPP in the setting of background VAPI. The association between vaping and MPP infection has not been established in the literature and this is the first documented report to establish a link between e-cigarettes and fulminant MPP. Further research is needed to confirm this association.