Facebook E-Cigarette Death Report

Published Jul 7, 2015

NEWS:   A June 2015 Facebook post claims a woman's neighbor died of suffocation due to e-cigarette use, but the claim has neither been substantiated nor reported upon in the news.

On 27 June 2015, a Facebook user published a status update claiming that she had just returned from the funeral of a neighbor, an unnamed 67-year-old woman, whose death was directly attributable to the use of "vapor ciggaretts" [sic] that had "coated the folliculs" [sic] of her lungs with oil:

The Facebook user who posted this information lists her location as Jacksonville, Florida, but she provided no details such as the date on which the death occurred, or whether the deceased suffered from any other medical conditions. In response to replies seeking permission to share the post, she added:

Please share, that was the purpose of this post. Who knew, she thought the vapor ciggaretts would be better than smoking. The Mayo Dr's said her lungs were clear otherwise.

The form of inflammation likely described by the poster is lipoid pneumonia, a condition neither exclusive to nor commonly associated with the use of electronic cigarettes (or various similar devices). A 2010 study that examined lipoid pneumonia (in the context of radiology and diagnostics) explained the conditions under which lipoid pneumonia typically presents (emphasis added):

Acute exogenous lipoid pneumonia typically manifests clinically as cough, dyspnea, and low-grade fever that usually resolve with supportive therapy. In contrast, patients with chronic exogenous lipoid pneumonia are frequently asymptomatic on presentation and are only identified because of an incidentally detected abnormality on radiologic imaging. Most of these patients are elderly (sixth or seventh decade of life); have an anatomic or functional alteration to swallowing, with a predisposition to aspiration; and have a history of topical application or ingestion of lipids. However, a history of exposure to animal fats or mineral or vegetable oils may not be elicited, and a careful clinical history to identify the source of aspirated or inhaled lipid may be required.

Whether such an analysis (to identify the source of aspirated or inhaled lipid) had been undertaken by examining doctors was not mentioned in the Facebook post. Published research on the risk of lipoid pneumonia resulting from e-cigarette use includes at least one patient treated in 2011: an article [PDF] published in the journal Chest, described a woman who experienced the first suspected case of lipoid pneumonia resulting from the use of e-cigarettes:

As discussed, most cases of exogenous lipoid pneumonia are associated with aspiration of mineral oil or lipid-based preparations. There is one published case of exogenous lipoid pneumonia due to inhaling vaporized weed oil. Other cases have been reported involving inhalation of crack cocaine mixed with petroleum jelly. To our knowledge, there are no prior published cases of exogenous lipoid pneumonia due to the use of glycerin-based e cigarettes.

The device and preparation used by the woman cited in the article were not described, but few e-cigarette users still utilize devices or preparations common in 2011 due to subsequent advancements in the technology of nicotine vaporization. Moreover, the article described additional environmental factors to which the woman had been exposed immediately prior to her diagnoses, including bedbug fumigation:

The patient reported a recent exposure to fumigation chemicals, as the result of a bedbug infestation of her apartment building 2 weeks prior to her hospitalization. She had no pets. There was no other history of significant exposures, illicit drug use, or recent travel. She denied any dysphagia or aspiration.

The 2011 case involving lipoid pneumonia in a user of e-cigarettes is widely cited but appears to be the only one of its kind in medical literature. A separate 2011 incident in the United Kingdom involved a man whose widow claimed he suffered lipoid pneumonia before his death that same year. However, subsequent reports indicated that the man used an "oil" in his e-cigarette, and that practice is neither common nor recommended for vaporized nicotine devices. Vegetable glycerin and propylene glycol are the only base liquids widely considered acceptable for use as a base in e-cigarette liquids.

A study published in the journal Therapeutic Advances in Drug Safety in April 2014 cited and refuted the claim made in Chest regarding the female patient diagnosed with lipoid pneumonia in 2011. The later study maintained that the carrier liquid in question could not have led to lipoid pneumonia:

Another case report of a patient with lipoid pneumonia was published, with the condition attributed to glycerin-based EC liquids used by the patient [McCauley et al. 2012]. However, glycerin is an alcohol (polyol) and thus it is impossible to cause lipoid pneumonia. Only oil-based liquids could be the cause for this condition; such liquids should not be used with ECs.

We've reached out to the Mayo Clinic in Jacksonville to inquire about the claims made in the Facebook post above. Despite strong media interest in the potential adverse effects of e-cigarettes, we've so far been unable to locate any news reports or other anecdotal accounts substantiating the claims of the Facebook user above.

Kim LaCapria is a former writer for Snopes.

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