Abstract Introduction Exogenous lipoid pneumonia (ELP) is a rare pulmonary condition classically caused by aspiration of mineral oils. With the surge of cannabis and CBD oil vaping, a modern inhalational phenotype has emerged, affecting younger adults. While acute presentations resembling EVALI are increasingly recognized, progressive fibrotic forms remain underreported. We present a rare case of chronic, fibrotic ELP resulting in pulmonary hypertension and transplant evaluation—representing an underappreciated outcome of long-term lipid aerosol inhalation. Case Report A 42-year-old man with a 20-year history of daily marijuana and CBD oil inhalation presented with progressive dyspnea and cough. Imaging revealed apical bullous emphysema with bilateral fat-density consolidations, interlobular septal thickening, and peri-lymphatic nodularity. Bronchoscopy was nondiagnostic. Despite exposure cessation and inhaled bronchodilator therapy, he demonstrated progressive obstruction (FEV1 42% predicted), declining DLCO, and new pre-capillary pulmonary hypertension (mean PAP 35 mmHg). Surgical lung biopsy showed lipid-laden foamy macrophages and vacuolated histiocytes with interstitial fibrosis, confirming chronic exogenous lipoid pneumonia. Owing to clinical and radiologic progression, he was referred for lung transplantation. Discussion This case highlights an aggressive fibrotic phenotype of ELP associated with chronic cannabis and CBD oil inhalation. Unlike acute vaping-related pneumonitis, chronic lipid deposition can trigger a maladaptive fibro-inflammatory response leading to irreversible fibrosis and WHO Group 3 pulmonary hypertension. The coexistence of emphysema and obstructive physiology underscores overlapping mechanisms of airway toxicity from cannabis and lipid aerosols. Recognition of this evolving inhalational exposure pattern is crucial, as early diagnosis and exposure cessation may prevent irreversible lung injury. This report broadens the clinical spectrum of ELP and calls for surveillance of vaping-associated fibrotic lung disease. Impact Statement This case is among the first to demonstrate a fibrotic, transplant-requiring phenotype of cannabis-related exogenous lipoid pneumonia, redefining the chronic consequences of vaping-related lipid inhalation and underscoring its potential to cause irreversible pulmonary hypertension. This abstract is funded by: None
Waqas et al. (Fri,) studied this question.