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Researchers looking into what’s injuring people who vape have been focused on oil coating the lungs, a form of pneumonia. Now another problem is surfacing: lungs that look like they’ve been chemically burned.

A recent study in the New England Journal of Medicine looked at 17 lung biopsies from serious vaping illnesses around the country. They all showed injuries associated with exposure to toxic chemicals like a worker who inhaled fumes at a chemical spill, or a soldier exposed to mustard gas.

Doctor Cathy Markin with Legacy Good Samaritan Hospital in Portland said the different illnesses hint at different causes.

“And that’s why this investigation is so complex,” Markin said. “Because it’s probably not just one thing about the vaping, or one factor about the person who vapes, that puts them at risk.”

Markin published an article eight years ago about a woman who vaped and suffered from pneumonia, long before the recent series of vape-related illnesses.

The Centers for Disease Control and Prevention now said it’s seen 1,299 confirmed and probable lung injury cases across 49 states, the District of Columbia and the U.S. Virgin Islands. It also reported 29 deaths.