Treatment of electronic cigarette or vaping product use‐associated lung injury (EVALI) by corticosteroid and low‐dose pirfenidone: Report of a case

Electronic (e)‐cigarette or vaping product use‐associated lung injury (EVALI) is a novel and potentially lethal disease first reported in the United States. We report the case of a 56‐year‐old man who presented to our hospital with dyspnoea and cough lasting for 2 months after using an e‐cigarette for approximately 50 puffs over 2 weeks. Physical examination revealed crackles in the left lower lung. High‐resolution computed tomography (HRCT) showed consolidation and ground‐glass opacities in both lungs. The baseline forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) were 65.7% and 63.9% of the predicted, respectively. Lung biopsy revealed organizing pneumonia with focal fibrosis. In addition to prednisolone, he was treated with a low‐dose pirfenidone (200 mg three times per day) due to the persistence of a mild cough, exertional dyspnoea and basal crackles after discharge. His symptoms and FVC significantly improved, but the recovery of the DLCO was slow. The follow‐up HRCT demonstrated only minimal fibrotic changes. To our knowledge, this was the first reported case of EVALI successfully treated with a combination of corticosteroid and antifibrotic agents.