B71-10 Vaping Associated Lung Abscess

Background With the first cases initially reported in 2019, E-cigarette/vaping associated lung injury (EVALI) has been associated with a spectrum of pulmonary diseases. Lung abscesses have rarely been described as a manifestation of EVALI. In this case report, we present a case of a right upper lobe lung abscess that developed in the setting of extensive vaping use, without any additional predisposing risk factors, which ultimately resolved with prolonged antibiotic therapy. Case Report A 22 year old female without any remarkable medical history presented to her primary care manager with nausea, vomiting, nasal congestion, and fatigue. She was diagnosed with acute otitis media and started on treatment with antibiotics, but at her follow up appointment one week later, she reported the development of a cough, fevers and chills. A chest x-ray was remarkable for a right upper lobe airspace disease suspicious of a cavitary lesion, and she was admitted for additional evaluation. The patient denied any risk factors for tuberculosis, aspiration history, atypical exposures, or exotic travel history. She reported regular vaping use, with one disposable vape cartridge every three weeks. Her workup was notable for a leukocytosis of 19.14 10x3/uL, platelets of 526 10x3/uL, and CRP of 196.4 mg/L (ULN = <5). A non contrast chest CT scan revealed the lesion measured 5.4 x 5.0 x 4.0 cm. Her sputum culture identified multiple organisms on gram stain, including rare gram-positive cocci and bacilli, rare gram negative bacilli and diplococci, with few Haemophilus parainfluenzae identified on final culture. A serum galactomannan, fungitell, QuantiFERON-Gold, HIV Ab/p24Ag test were negative. Multiple acid fast sputum cultures for Mycobacterium tuberculosis returned negative. Ultimately, she was started on ampicillin-sulbactam with a favorable treatment response, and she completed approximately four weeks of antibiotic therapy with amoxicillin-clavulanic acid. By the end of antibiotic therapy, her symptoms had abated, and a follow up chest CT scan at the conclusion of treatment demonstrated resolution of the right upper lobe lesion. Based on the absence of any clear cause of her lung abscess, the etiology was attributed to her vaping use. Conclusion EVALI has been described as an acute lung injury classically associated with multiple lung diseases, including diffuse alveolar hemorrhage, acute respiratory distress syndrome, or interstitial lung disease. However, clinicians should be aware of this rare association between lung abscesses and e-cigarettes, especially as the use of these products continues to increase.