Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia


Electronic cigarettes, pens, cartridges and other devices were developed as nicotine delivery systems not requiring combustion of tobacco leaves. This technology was subsequently employed to deliver the cannabis component tetrahydrocannabinol (THC) via products often manufactured without adequate quality oversight and sold illegally. Recently, five patients presenting within a 2-month period with acute respiratory failure due to acute lipoid pneumonia after inhaling THC-containing concentrates or oils have been described. We report a 28-year-old previously healthy man who presented in acute respiratory failure 2 weeks after initiating use of a street-purchased THC-containing vape cartridge. Bronchoalveolar lavage cytology with oil red O staining confirmed the diagnosis of acute lipoid pneumonia. Diffuse alveolar hemorrhage and eosinophilic pneumonia were excluded. Evolving evidence supports a clinical entity of acute respiratory failure due to acute, exogenous lipoid pneumonia induced by THC-containing concentrates or oils inhaled through a variety of vaping products. All six patients reported to date received intravenous corticosteroids and survived to hospital discharge.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Davidson K, Brancato A, Heetderks P, Mansour W, Matheis E, Nario M et al (2019) Outbreak of electronic-cigarette-associated acute lipoid pneumonia—North Carolina, July–August 2019. MMWR Morb Mortal Wkly Rep 68(36):784–786. https://doi.org/10.15585/mmwr.mm6836e1

  2. 2.

    CDC (2019) Health advisory: severe pulmonary disease associated with use of e-cigarette products. US Department of Health and Human Services, CDC, Atlanta. https://emergency.cdc.gov/han/han00421.asp

  3. 3.

    Hadda V, Khilnani GC (2010) Lipoid pneumonia: an overview. Expert Rev Respir Med 4(6):799–807

  4. 4.

    Marchiore E, Zanetti G, Mano CM, Hochhegger B (2011) Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med 105(5):659–666

  5. 5.

    Viswam D, Trotter S, Burge PS, Walters GI (2018) Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Case Rep. https://doi.org/10.1136/bcr-2018-224350

  6. 6.

    Itoh M, Aoshiba K, Herai Y, Nakamura H, Takemura T (2017) Lung injury associated with electronic cigarettes inhalation diagnosed by transbronchial lung biopsy. Respir Case Rep 6(1):e00282

  7. 7.

    McCauley L, Markin C, Hosmer D (2012) An unexpected consequence of electronic cigarette use. Chest 141(4):1110–1113

  8. 8.

    Arter ZL, Wiggins A, Hudspath C, Kisling A, Hostler DC, Hostler JM (2019) Acute eosinophilic pneumonia following electronic cigarette use. Respir Med Case Rep 18(27):100825

  9. 9.

    Agustin M, Yamamoto M, Cabrera F, Eusebio R (2018) Diffuse alveolar hemorrhage induced by vaping. Case Rep Pulmonol 2018:9724530

  10. 10.

    Sommerfeld CG, Weiner DJ, Nowalk A, Larkin A (2018) Hypersensitivity pneumonitis and acute respiratory distress syndrome from e-cigarette use. Pediatrics 141(6):e20163927

  11. 11.

    Khan MS, Khateeb F, Akhtar J, Khan Z, Lal A, Kholodovych V et al (2018) Organizing pneumonia related to electronic cigarette use: a case report and review of literature. Clin Respir J 12(3):1295–1299

Download references

Author information

Correspondence to Peter V. Dicpinigaitis.

Ethics declarations

Conflicts of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dicpinigaitis, P.V., Trachuk, P., Fakier, F. et al. Vaping-Associated Acute Respiratory Failure Due to Acute Lipoid Pneumonia. Lung 198, 31–33 (2020). https://doi.org/10.1007/s00408-019-00277-6

Download citation


  • Vaping
  • Electronic cigarette
  • Tetrahydrocannabinol (THC)
  • Lipoid pneumonia
  • Acute respiratory failure
  • Nicotine