The use of electronic nicotine delivery systems (ENDS) is increasing across the United States astobacco bans increase and more people use these devices in an attempt to quit smoking. They areunregulated by the Food and Drug Administration, and there is significant concern that ENDS couldproduce several toxic byproducts.

In this case a 35-year-old female presented to the emergency department with sudden-onsetdyspnea. She denied current tobacco smoking, but she was a user of ENDS. When bronchoscopywas performed, an extensive pattern of suspected chemical injury was noted in her airways. Sherequired transfer to a tertiary center where she required extracorporeal membranous oxygenation.

Despite public opinion that ENDS are generally safe, or at least safer than tobacco smoking,contrary evidence is mounting. We postulate that her injuries were likely suffered secondary to useof an ENDS.