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This could indicate past exposure with colonisation which has been reported in adult and paediatric populations.9 10 This could also indicate early reinfection, and there have been case reports of mycoplasma being implicated in the pathogenesis of EVALI.11 Because EVALI is a diagnosis of exclusion a comprehensive rheumatological evaluation was performed along with a transthoracic echocardiogram to rule out alternative aetiologies, all of which were normal (table 1)

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In its last full year of operation, 2018, the unit seized more than four million contraband smokes