Case Report Vaping and Commitment Flu-B Infection Is a Deadly Combination for Spontaneous Pneumomediastinum Md Didar Ul Alam , 1,2 Khandakar Hussain, 1,2 Samsone Garedew, 2 and Muhammad imtiaz 1 1 Department of Internal Medicine, Conemaugh Medical Memorial Center, Johnstown, PA, USA 2 Department of Hospital Medicine, Conemaugh Medical Memorial Center, Johnstown, PA, USA Correspondence should be addressed to Md Didar Ul Alam; didar.134@gmail.com Received 4 March 2021; Accepted 31 May 2021; Published 18 June 2021 Academic Editor: Tun-Chieh Chen Copyright © 2021 Md Didar Ul Alam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Vaping or E-cigarettes were created to deliver nicotine-containing aerosol to users with a flavoring agent without agents such as tars, oxidant gases, and carbon monoxide smoke found in traditional tobacco cigarettes. The use of E-cigarettes is steadily increasing in the United States, especially among the young population. Electronic cigarettes seem capable of causing various injury patterns in the lungs, collectively called E-cigarettes or vaping-associated lung injury (EVALI). Spontaneous pneumomediastinum (SPM) is a rare finding in EVALI. Here, we report a case of spontaneous pneumomediastinum secondary to vaping in a young man with no past medical history except for daily vaping and a recent untreated influenza infection. 1. Introduction Pneumomediastinum is defined as the presence of air or other gas in the mediastinum also known as mediastinal emphysema [1]. Pneumomediastinum can be categorized as spontaneous pneumomediastinum (SPM) and secondary pneumomediasti- num. Secondary pneumomediastinum is caused by blunt or penetrating chest wall trauma, barotrauma from mechanical ventilation, underlying airway diseases, endobronchial, and esophageal perforation. Vaping or E-cigarettes gained popular- ity over the last few years. E-cigarettes containing nicotine and other substances vaporize or produce aerosols, which the users then inhale. Predisposing conditions or triggers are identified in some cases of pneumomediastinum in children. A respiratory illness that led to pneumomediastinum, especially during acute exaggeration with excessive coughing, i.e., in asthma and respi- ratory infections, is identified in children and adolescents [2–5]. The unique aspect was that the development of SPM was trig- gered by excessive coughing from untreated influenza infection in an otherwise healthy young man with concomitant lung injury from daily vaping. 2. Case Presentation A 22-year-old male was brought to the emergency depart- ment (ED) for cough and progressive shortness of breath for the last six days. His past medical history is unremarkable except for daily vaping. A week ago he also tested positive for influenza B when he had chills, fatigue, and sore throat. He did not take oseltamivir due to a late prescription from his primary care physician. He had low-grade fever with nausea and vomiting with fierce cough four days before presentation to ED. He also felt crepitus in the neck. He did not have any prior chest surgical history or any history of illicit drug abuse. In the ED, his temperature was 99.1 degrees Fahrenheit, blood pressure of 150/95 mmHg, heart rate of 136 beats/min, and a saturation of 91% on 3 L nasal cannula (NC) oxygen. On physical examination, subcutaneous emphysema was noted in the anterior cervical region. Blood work showed leu- kocytosis of 18,000/mL and a procalcitonin level of 0.21 ng/mL. Chest X-ray (CXR) showed pneumomediastinum with subcutaneous emphysema extending into the cervical region with bilateral pneumonia (Figure 1). Hindawi Case Reports in Pulmonology Volume 2021, Article ID 9944491, 4 pages https://doi.org/10.1155/2021/9944491