E-Cigarette or Vaping Product Use–Associated Lung Injury (EVALI) mimicking chronic interstitial lung disease in a young adult: a case report

Background E-cigarette or vaping product use–associated lung injury may show variable clinical, radiologic, and histopathologic patterns. Although it usually presents as acute or subacute lung injury, chronic or atypical forms may mimic interstitial lung disease and lead to diagnostic delay. This case highlights an uncommon interstitial lung disease–like presentation of vaping-associated lung injury in a young adult. Case presentation A 32-year-old man presented with progressive exertional dyspnea and worsening radiologic abnormalities despite previous treatment for presumed interstitial lung disease. The patient remained under a presumed chronic ILD diagnosis for almost two years before detailed reassessment of the exposure history and re-evaluation of the lung biopsy prompted diagnostic reconsideration. Serial thoracic computed tomography showed progressive bilateral ground-glass opacities and interstitial changes. Reassessment of exposure history revealed daily e-cigarette use, particularly during periods of symptom worsening. Re-evaluation of the prior surgical lung biopsy demonstrated a macrophage-predominant smoking-related injury pattern with desquamative interstitial pneumonia–like features and no typical findings of usual interstitial pneumonia or nonspecific interstitial pneumonia. Based on an integrated assessment of the clinical, radiologic, pathologic, and exposure findings, e-cigarette or vaping product use-associated lung injury was considered the most likely diagnosis. After cessation of e-cigarette use and high-dose corticosteroid therapy, the patient showed marked clinical and radiologic improvement. Conclusions Vaping-associated lung injury should be considered in young patients with progressive dyspnea and interstitial lung disease–like imaging, especially when the clinical course is atypical or treatment response is poor. Careful exposure history and multidisciplinary radiologic–pathologic reassessment may facilitate recognition and appropriate diagnostic reconsideration.