An Unexpected Myriad of Pulmonary Complications Following Vaping and Anabolic Steroid Use
Recommended Citation
Cherabuddi MR, Bradley P. An Unexpected Myriad of Pulmonary Complications Following Vaping and Anabolic Steroid Use. Am J Respir Crit Care Med 2025; 211:A6370.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Introduction Vaping use is known to cause multiple radiologic pulmonary abnormalities including bilateral ground-glass opacities, consolidation, interlobular septal thickening, reversed halo sign and can present as organizing pneumonia, diffuse alveolar hemorrhage and occasionally eosinophilic pneumonia. Anabolic steroid use can cause lung injury, which may present as acute respiratory distress syndrome, pulmonary edema or thromboembolic events, although not well studied. We present a case of a young male with vaping and anabolic steroid use resulting in multiple pulmonary complications and prolonged ventilator dependence. Case Description A young previously healthy male with recent vaping and anabolic steroid use for one year, presented with cough and shortness of breath after being exposed to sick contacts and required intubation for hypoxia. Initial workup was notable for positive influenza A, and respiratory culture with Streptococcus pneumoniae. Chest computed tomography demonstrated bilateral multifocal ground-glass opacities, numerous pneumatoceles predominant in both lower lobes and the lingula, largest in left lower lobe 5.9 x 5.5 x 8.8 cm, with no prior imaging for comparison. He was treated with oseltamivir and ceftriaxone. Due to difficult ventilator liberation and concern for infection, repeat chest imaging was done showing right apical pneumothorax, pneumomediastinum, new air fluid levels in pneumatoceles concerning for infection as well as pericardial effusion without evidence of tamponade. He was treated with ampicillin-sulbactam, required chest tube placement and pressors in the setting of obstructive shock. He was not to be a candidate for extracorporeal membrane oxygenation given the timing of his initial insult and not a transplant candidate due to active infection with ongoing complications. He remained ventilator-dependent for 25 days, eventually underwent tracheostomy and gastrostomy tube placement, was discharged to a inpatient rehabilitation facility, is now recovering well since discharge home. Discussion Vaping and anabolic steroid use are known to cause lung injury, though are not typically associated with the development of pneumatoceles. Influenza complicated by streptococcal pneumonia generally does not lead to pneumatoceles either. In this case, the presence of pneumatoceles likely resulted in complications such as pneumothorax, lung abscesses, and prolonged ventilator dependence. The rising prevalence of vaping and anabolic steroid use may result in unexpected lung injuries, making it crucial to recognize atypical clinical presentations. Early transfer to ECMO-capable centers should be prioritized to enhance patient outcomes in severe cases. Monitoring patients with a history of vaping or steroid use for complications is essential, as their clinical presentations may differ from conventional cases.
Volume
211
First Page
A6370
