E-cigarette or vaping product use-associated lung injury without pulmonary symptoms: A case report and literature review.

RATIONALE: E-cigarette or vaping product use-associated lung injury (EVALI) is a rare pulmonary condition linked to the use of e-cigarettes or vaping products. The primary symptoms of EVALI are respiratory, including shortness of breath and cough. It is rare for cases to present without pulmonary symptoms. The absence of typical symptoms often leads to clinical misdiagnosis or oversight. PATIENT CONCERNS: We present a 33-year-old male with a history of e-cigarette use and allergic rhinitis. He initially sought care for recurrent nasal congestion in the absence of pulmonary symptoms; however, chest imaging unexpectedly revealed extensive lung shadows. DIAGNOSES: Laboratory results ruled out bacterial, fungal, and viral infections. These findings, along with his history of e-cigarette use, imaging features, and lung pathology, led to the final diagnosis of EVALI. INTERVENTIONS: The patient then received glucocorticoid therapy: oral prednisone acetate tablets 20 mg once daily for 14 days followed by a standardized tapering regimen. OUTCOMES: His condition showed clinical improvement with glucocorticoid therapy, and lung shadows were reduced on imaging. A 2-year follow-up revealed no signs of recurrence. LESSONS: We emphasize that although EVALI without pulmonary symptoms is rare, it should be included in the differential diagnosis for individuals with a history of e-cigarette use who present with atypical or extrapulmonary manifestations.