C62-22 A Clouded Diagnosis: Sarcoidosis in a Teen Vaper

Abstract Introduction Sarcoidosis in adolescents is uncommon. While vaping has been associated with significant pulmonary inflammation and injury, a causal relationship with sarcoidosis has not been established. We present a case of biopsy-proven pulmonary sarcoidosis in a 17-year-old male with chronic vape exposure. Case A 17-year-old male presented with progressive dyspnea and hypoxia. Over nine months, he reported a productive cough, intermittent chest discomfort, decreased exercise tolerance, and a 10-pound weight loss. He had vaped regularly for one year, using one cartridge every 2-3 weeks. He denied fever, arthralgias, rashes, or night sweats. His history was notable only for premature birth at 35 weeks, with no chronic illness or family history of pulmonary or autoimmune disease. Initial evaluation demonstrated mildly elevated inflammatory markers (CRP 10 mg/dL, ESR 28 mm/hr) and a normal leukocyte count with occasional reactive lymphocytes. Chest radiography revealed diffuse miliary infiltrates; CT imaging showed extensive bilateral pulmonary nodules with peribronchial thickening. Infectious, metabolic, and autoimmune workups—including ACE level, ANCA, ANA, and hypersensitivity pneumonitis panel—were negative. Bronchoscopy with bronchoalveolar lavage demonstrated pan-bronchitis with alveolar macrophage predominance and neutrophilia. Negative cultures. Pulmonary function testing revealed severe obstruction with air trapping, mild restriction, and moderately reduced diffusing capacity. Following initiation of systemic corticosteroids, oxygen was discontinued, and pulmonary function improved (FEV₁ 49% from 30%; DLCO 70% from 57%). Persistent abnormalities prompted a video-assisted thoracoscopic lung biopsy, which revealed subpleural non-necrotizing granulomas along broncho-vascular bundles and interlobular septae with associated fibrosis, consistent with sarcoidosis. The patient was subsequently started on methotrexate and continued on a corticosteroid taper, resulting in normalization of lung function and sustained clinical improvement. Discussion This case represents an atypical presentation of sarcoidosis in an adolescent and highlights a potential link between vaping and granulomatous lung disease. Although cigarette smoking has shown an inverse relationship with sarcoidosis, the evolving composition of vaping aerosols introduces novel antigens that may trigger immune dysregulation. Further investigation is warranted to elucidate the potential role of vaping as an environmental precipitant in pediatric sarcoidosis. This abstract is funded by: NA