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Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use

Daffolyn Rachael Fels Elliott, Rupal Shah, Catherine Ann Hess, Brett Elicker, Travis S. Henry, Ana Maria Rule, Rui Chen, Mehdi Golozar, Kirk D. Jones
European Respiratory Journal 2019 54: 1901922; DOI: 10.1183/13993003.01922-2019
Daffolyn Rachael Fels Elliott
1Dept of Pathology, University of California San Francisco, San Francisco, CA, USA
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  • ORCID record for Daffolyn Rachael Fels Elliott
Rupal Shah
2Dept of Medicine, University of California San Francisco, San Francisco, CA, USA
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Catherine Ann Hess
3School of Public Health Prevention Research Center, University of California Berkeley, Berkeley, CA, USA
4Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Brett Elicker
5Dept of Radiology, University of California San Francisco, San Francisco, CA, USA
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Travis S. Henry
5Dept of Radiology, University of California San Francisco, San Francisco, CA, USA
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Ana Maria Rule
4Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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  • ORCID record for Ana Maria Rule
Rui Chen
4Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mehdi Golozar
6Dept of Engineering, University of Cambridge, Cambridge, UK
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Kirk D. Jones
1Dept of Pathology, University of California San Francisco, San Francisco, CA, USA
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  • For correspondence: kirk.jones@ucsf.edu
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Extract

The spectrum of pulmonary disease caused by e-cigarette use is currently emerging and appears to be multifaceted [1]. We describe a patient who developed pathologically documented giant cell interstitial pneumonia following regular use of an e-cigarette. This disorder has been termed hard metal pneumoconiosis, or cobalt lung, due to its close association with exposure to hard metal (cemented tungsten carbide with cobalt) [2]. Analysis of the device's e-liquid revealed significant levels of cobalt, supporting a diagnosis of giant cell interstitial pneumonia associated with inhaled cobalt from regular e-cigarette use.

Abstract

An e-cigarette user developed giant cell interstitial pneumonia, a rare disease largely limited to work exposure to hard metals, including cobalt. Analysis of the e-liquid identified significant levels of cobalt, supporting the e-cigarette's causative role. http://bit.ly/2VRcT1U

Acknowledgement

We thank Sunita Ho and Misun Kang of the UCSF Biomaterial and Bioengineering Correlative Microscopy Core. The authors appreciate the critical and constructive comments of the reviewers. This case was alluded to in a recent correspondence (Henry TS, Kanne JP, Kligerman SJ. Imaging of vaping-associated lung disease. N Engl J Med 2019; 381: 1486–1487).

Footnotes

  • Conflict of interest: D.R. Fels Elliott has nothing to disclose.

  • Conflict of interest: R. Shah has nothing to disclose.

  • Conflict of interest: C.A. Hess has nothing to disclose.

  • Conflict of interest: B. Elicker has nothing to disclose.

  • Conflict of interest: T.S. Henry has nothing to disclose.

  • Conflict of interest: A.M. Rule has nothing to disclose.

  • Conflict of interest: R. Chen has nothing to disclose.

  • Conflict of interest: M. Golozar has nothing to disclose.

  • Conflict of interest: K.D. Jones has nothing to disclose.

  • Received September 27, 2019.
  • Accepted October 16, 2019.
  • Copyright ©ERS 2019
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Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use
Daffolyn Rachael Fels Elliott, Rupal Shah, Catherine Ann Hess, Brett Elicker, Travis S. Henry, Ana Maria Rule, Rui Chen, Mehdi Golozar, Kirk D. Jones
European Respiratory Journal Dec 2019, 54 (6) 1901922; DOI: 10.1183/13993003.01922-2019

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Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use
Daffolyn Rachael Fels Elliott, Rupal Shah, Catherine Ann Hess, Brett Elicker, Travis S. Henry, Ana Maria Rule, Rui Chen, Mehdi Golozar, Kirk D. Jones
European Respiratory Journal Dec 2019, 54 (6) 1901922; DOI: 10.1183/13993003.01922-2019
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