D103-14 When the Tissue Speaks: Unmasking E-Cigarette or Vaping-Associated Lung Injury Presenting as Endobronchial Mass Lesions in a Patient Denying Vaping

Abstract Endobronchial masses in young adults are rare and often raise concerns for malignancy, infection, granulomatous disease, or chemical injury. While E-cigarette or Vaping Use-Associated Lung Injury (EVALI) typically affects lung parenchyma, endobronchial involvement is uncommon. We present a unique case of endobronchial EVALI, highlighting the potential harms of chemical and metallic constituents in vaping products, and the diagnostic challenges posed by limited clinical guidelines and the lack of FDA regulation. A 32-year-old previously healthy South Asian man presented with persistent cough, hemoptysis, fatigue, and low-grade fever. He denied a history of smoking or vaping at this time, recounting only limited second-hand exposure. He also denied having indoor pets. Initial treatment for presumed moderate asthma and cough-variant asthma—including inhalers, corticosteroids, and antibiotics—was ineffective. Tuberculosis and other infectious and autoimmune work-ups were negative. Chest CT showed polypoid thickening of the left main bronchus, prompting bronchoscopy. The patient traveled back to India briefly, where his initial bronchoscopy was performed with forceps, and revealed benign lesions in the left mainstem bronchus and lower trachea with negative cultures. Repeat bronchoscopy in the US demonstrated lesion progression involving the left mainstem, lower trachea, and right upper lobe. Pathology identified refractile material in histiocytes, suggestive of EVALI. The patient was treated with oral corticosteroids, Azithromycin, and Itraconazole. A subsequent bronchoscopy with cryoprobe and argon plasma coagulation (APC) debulking confirmed benign chronic inflammation with vacuolated histiocytes, iron deposition, and debris. Upon further questioning, the patient finally admitted to vaping. Histopathology showed benign bronchial epithelium with no evidence of granulomas, malignancy, or infections. Beyond its clinical novelty, this case highlights broader concerns about the ongoing lack of safety and toxicology regulations governing both the formulation and hardware of electronic nicotine delivery systems. The absence of standardized manufacturing and emission requirements raises significant health concerns, as neither users nor clinicians fully understand the true extent of exposure to nicotine, cannabinoids, and heavy metals produced by these devices. Equally important are the social dimensions of this case. The patient’s initial denial of vaping highlights the role of social stigma and cultural norms in shaping disclosure during medical encounters. In populations where nicotine or inhalant substances are socially discouraged, patients may hesitate to disclose relevant exposure histories, thereby delaying accurate diagnosis and treatment. This case adds to the limited literature on EVALI as a cause of obstructive endobronchial lesions and underscores the urgent need for systematic research and regulatory oversight. This abstract is funded by: None