Empyema Associated with Vaping: Documented Cases
Yes, there is at least one documented case of empyema directly attributed to vaping in an otherwise healthy patient, involving bacterial pneumonia that rapidly progressed to empyema. 1
Case Report Evidence
A 2023 case report published in BMJ Case Reports describes a previously healthy patient who developed pneumonia caused by Pseudomonas fluorescens that was complicated by rapidly developing empyema, directly attributed to e-cigarette/vaping product use. 1
This case demonstrates that vaping can increase susceptibility to respiratory tract infections that may progress to serious complications like empyema, even in patients without underlying health conditions. 1
EVALI and Severe Pulmonary Complications
While empyema specifically is rarely reported, the broader category of severe vaping-related lung injuries is well-documented:
The 2019 EVALI outbreak resulted in over 2,800 hospitalized cases and 68 deaths in the United States as of February 2020, predominantly affecting young adults. 2, 3
Vitamin E acetate, an additive in some THC-containing e-cigarettes, was strongly linked to EVALI based on bronchoalveolar lavage fluid testing, though other chemicals in both THC and non-THC products may also contribute. 2, 4
EVALI presents with respiratory symptoms including cough, shortness of breath, chest pain, along with systemic symptoms like fever, nausea, vomiting, and weight loss—symptoms that overlap with infectious complications. 2, 5
Mechanism of Increased Infection Risk
E-cigarettes contain and emit numerous potentially toxic substances beyond nicotine that can damage respiratory defenses. 3, 6
Vaping can cause acute lung injury through multiple mechanisms, including high-power heating elements producing toxic byproducts, even without THC, vitamin E acetate, or nicotine. 7
The lung injury from vaping may create conditions favorable for secondary bacterial infections that could progress to empyema. 1
Clinical Implications
When evaluating young adults (late teens to mid-30s) with pneumonia or empyema, specifically ask about all forms of tobacco and vaping product use, including both nicotine and THC products. 3, 6
Consider vaping-associated lung injury in the differential diagnosis when young, otherwise healthy patients present with severe or rapidly progressive respiratory infections. 5, 1
EVALI remains a diagnosis of exclusion requiring high clinical suspicion, as there are no specific diagnostic biomarkers. 5, 4, 8
Important Caveats
The exact pathophysiology linking vaping to empyema development is not fully elucidated, but the documented case and increased infection susceptibility provide biological plausibility. 1
While empyema cases are rare in the vaping literature compared to EVALI, the absence of extensive reports may reflect underrecognition or underreporting rather than true rarity. 5
Standard empyema pathogens (Streptococcus pneumoniae, Staphylococcus aureus, anaerobes) should still be covered empirically, but unusual organisms like Pseudomonas fluorescens have been documented in vaping-associated cases. 9, 1