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An 18-year-old man presented to the emergency department of a community hospital with a cough, fever, night sweats and significant weight loss. He recently completed an antibiotic course for a lower respiratory-tract infection. Full blood count revealed a normal total white cell count with eosinophil count of 0.85×109/L. C-reactive protein (CRP) was normal but erythrocyte sedimentation rate (ESR) was 100 mm/hour. Chest radiograph demonstrated bilateral perihilar reticulonodular opacification with peripheral sparing (figure 1A). Immunoglobulin E was mildly elevated at 175UI/mL; other immunoglobulin levels, viral and autoantibody panels were normal. High-resolution CT thorax revealed diffuse centrilobular and peribronchovascular ground-glass opacification throughout both lungs with subpleural sparing (figure 1B/C). On further questioning, the patient disclosed a history of extensive vaping in the preceding 6 months including nicotine and tetrahydrocannabinol-containing products. He was referred to a specialist …
OO and KS are joint first authors.
Contributors All authors contributed to the conception, data collection and writing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.
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