Severe Pulmonary Blastomycosis in a Young Adult: Probable Role of E-Cigarette Use in Immunosuppression.

Background

E-cigarette use has become increasingly prevalent among young adults, raising concerns about its potential health impact and susceptibility to infections. Blastomyces dematitidis, the causative agent of blastomycosis, is a dimorphic fungus endemic to certain regions of the United States. We present a rare presentation of pulmonary blastomycosis in a young, immunocompetent male with chronic e-cigarette use, highlighting the need to consider fungal infections in the differential diagnosis of pneumonia of unknown etiology in patients with risk factors for respiratory illness. Presentation: A 20-year-old male with a 4-year history of daily e-cigarette use and gutter cleaner by occupation presented with a 10-day history of worsening cough, bloody sputum, shortness of breath, night sweats, fever, and weight loss. He was hemodynamically stable, required minimal oxygen support, and was admitted for chest X-ray showing right upper lobe pneumonia and cavitary lesion. The patient was tested for community-acquired pneumonia, atypical pneumonia, granulomatous diseases, and immunosuppressive and viral lymphoproliferative disorders. A diagnostic bronchoscopy ultimately confirmed blastomycosis, leading to treatment with amphotericin B and itraconazole, resulting in significant clinical improvement.

Conclusion

Pulmonary blastomycosis often presents asymptomatically, with severe cases more common in the elderly or those with comorbidities and immune dysfunction. Physicians tend to overlook it as a differential diagnosis for primary lung infections, focusing on bacterial pneumonia and tuberculosis in younger individuals. This case underscores the need for further investigation into the impact of e-cigarette use on immune function. This case also highlights the importance of making blastomycosis a reportable disease in Georgia, considering its increasing incidence and the widespread construction and soil disturbance occurring throughout the state.