C62-22 A Clouded Diagnosis: Sarcoidosis in a Teen Vaper
Abstract
Sarcoidosis in adolescents is uncommon. While vaping has been associated with significant pulmonary inflammation and injury, a causal relationship with sarcoidosis has not been established. We present a case of biopsy-proven pulmonary sarcoidosis in a 17-year-old male with chronic vape exposure.
A 17-year-old male presented with progressive dyspnea and hypoxia. Over nine months, he reported a productive cough, intermittent chest discomfort, decreased exercise tolerance, and a 10-pound weight loss. He had vaped regularly for one year, using one cartridge every 2-3 weeks. He denied fever, arthralgias, rashes, or night sweats. His history was notable only for premature birth at 35 weeks, with no chronic illness or family history of pulmonary or autoimmune disease. Initial evaluation demonstrated mildly elevated inflammatory markers (CRP 10 mg/dL, ESR 28 mm/hr) and a normal leukocyte count with occasional reactive lymphocytes. Chest radiography revealed diffuse miliary infiltrates; CT imaging showed extensive bilateral pulmonary nodules with peribronchial thickening. Infectious, metabolic, and autoimmune workups—including ACE level, ANCA, ANA, and hypersensitivity pneumonitis panel—were negative. Bronchoscopy with bronchoalveolar lavage demonstrated pan-bronchitis with alveolar macrophage predominance and neutrophilia. Negative cultures. Pulmonary function testing revealed severe obstruction with air trapping, mild restriction, and moderately reduced diffusing capacity.…
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