Vanishing Lung Syndrome in a Patient with HIV Infection and Heavy Marijuana Use

Vanishing lung syndrome (VLS) is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS), with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT), characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking. 1. Introduction Vanishing lung syndrome, also termed giant bullous emphysema (GBE), is a rare syndrome first described by Burke in 1937 [1]. It is an idiopathic and distinct clinical syndrome that affects young men, usually smokers. It causes severe progressive dyspnea and is characterized by extensive, predominantly asymmetric upper lobe bullous emphysema, which may eventually lead to respiratory failure [2]. Case reports have suggested an additive role of marijuana smoking in the development of this disease in young male smokers where tobacco consumption was less than what is commonly associated with the development of emphysema (i.e., less than 20 pack years) [3, 4]. We report a case of a 65-year-old male diagnosed with end stage emphysema for 3 years, AIDS, and a history of heavy marijuana smoking. He presents to the hospital in acute respiratory distress with multiple large peripheral lung bullae on chest CT consistent with vanishing lung syndrome. 2. Case Presentation A 65-year-old Hispanic male was brought to the emergency department due to severe shortness of breath at home. The shortness of breath started approximately one week prior to presentation and had progressively worsened over time. Upon arrival to the emergency department the patient was hypoxemic and in severe