Source: Annual Congress 2002 - Smoking habits in teenagers
Disease area: Interstitial lung diseases

Abstract

Smoking of illicit drugs, such as cocaine crack or heroin, has markedly increased in the last years, partially replacing nasal inhalation and IV injection use.Cocaine when smoked can cause minor non-specific symptoms like cough chest pain, dyspnoea, haemoptysis and bronchial spasm and more rarely non-cardiogenic pulmonary edema, pulmonary infiltrates with eosinophilia, acute alveolar hemorrhage and BOOP.
A 31 year-old man was admitted to our pulmonary department in April 2001, with acute onset of haemoptysis. His clinical history was unremarkable, except for cocaine use (smoking and nasal insufflation). On admission, the patient complained of chest pain, moderate fever, cough, and mild dyspnoea.During hospitalization were performed: chest x-ray and CT scan, bronchoscopy, blood tests, bacteriological and virological tests.Chest radiography showed diffuse micronodular interstitial infiltrates with hilar congestion.CT scanning of the thorax showed an image of ground-glass with alveolar filling, prevailing in lower lobes and hili, consistent with a diffuse hemorrhage. Bronchoscopy revealed a small amount of blood in the respiratory airways, mainly coagulated and a congested bronchial mucosa, mainly on the right side. Routine blood tests were normal.Bacteriological and virological tests, turned out to be negative.Clinical history and findings addressed to the diagnosis of cocaine induced pulmonary hemorrhage, a recently discovered and currently rare clinical entity in Italy. In fact, out of 119.503 consults performed in our Hospital during the last year, only 18 patients had symptoms related to cocaine use and just one had cocaine induced pulmonary hemorrhage. Therefore the use of illicit drugs should always be investigated in the differential diagnosis of pulmonary diseases.


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Citations should be made in the following way:
A. L. Comi, A. Miadonna (Milan, Italy). Pulmonary injury induced by cocaine smoking: a case report. Eur Respir J 2002; 20: Suppl. 38, 901

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