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A leading respiratory physician in Thailand announced the country’s first official case of vaping-related lung illness on Saturday.

In a social media post, Manoon Leechawengwongs, doctor and critical care specialist at Vichaiyut Hospital in Bangkok, detailed the case of a 48-year-old lung cancer patient suffering from pneumonia and respiratory failure. Manoon diagnosed the man with EVALI (electronic cigarette, or vaping product, use-associated lung injury) after learning that he had recently been using a THC vape pen. EVALI is also known as vaping-associated pulmonary injury, or VAPI.

This March, the patient began using Ceritinib, a traditional lung cancer medication, and his condition quickly began to improve. But by August, the man began to cut back his dose after hearing word-of-mouth advice that taking too much of this medicine could damage his health. The patient then ordered a cannabis vape pen from the US, hoping to find a natural cure for his illness.

Starting in November, the man began to vape CBD and THC extracts twice a day, while also taking cannabis oils sublingually. Within two weeks, the patient began to feel increasingly fatigued, and by November 15, he was hospitalized with a fever, coughing, and breathing difficulties – symptoms commonly associated with EVALI. Three days after being admitted, the man’s condition worsened, and he was sent to intensive care for artificial respiration.

X-rays revealed that the man was suffering from pneumonia. “The blemishes in the lungs indicated that the pneumonia was not caused by an infection nor does it look like the cancer was spreading,” Manoon wrote, according to Coconuts Bangkok. The patient began receiving steroids to treat his condition, and has slowly begun to improve.

Medical marijuana has been legal in Thailand for almost one year now, and the country’s health department began supplying bottles of full-extract CBD oil to patients in hospitals this summer. The country only allows medical cannabis to be dispensed in the form of raw oils, but Thai researchers are already hard at work developing their own strains of weed with unique blends of THC and CBD.

Manoon’s description of the case did not indicate whether the patient was also importing cannabis vape carts from the US, or if he was vaping home-grown weed extracts. It is also uncertain whether the man purchased his vape pen on the black market, or acquired a regulated product from a state where weed is legal. Considering that US states prohibit local weed companies from shipping their products out-of-state (and especially out of the country), it is more likely that the vape was acquired on the black market.

Many cases of EVALI reported in the US have been linked to black market THC vapes. Health officials currently suspect that the illness could be caused by vitamin E acetate, an additive generally only used in illegal vapes, but other researchers have proposed that heavy metal or pesticide contamination could be responsible for this dangerous illness.