CRACK LUNG MIMICKING INFECTIOUS PNEUMONIA

Abstract

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cocaine is responsible for innumerable visits to the emergency department and a frequent cause of death. It is the most used drug worldwide after marihuana. An estimated 1.9 million people over the age of 12 had used cocaine in the last month. Toxicity can affect multiple systems such as the cardiovascular, respiratory, and central nervous systems. Lung damage is caused by different mechanisms such as direct cellular toxicity, thermal airway injury, barotrauma, inflammatory damage, and vasospasm leading to ischemia that could lead to respiratory failure. Here is an intriguing case secondary to this highly addictive drug. CASE PRESENTATION: A 28-year-old inmate with a history of hypertension, bronchial asthma, and illicit drug abuse arrived at the emergency department with episodes of hemoptysis. Symptoms began the day before his arrival, accompanied by shortness of breath, dizziness, and cough. Vital signs were tachycardia, tachypnea, and desaturation requiring oxygen supplementation. Physical exam was notable for bilateral wheezing and rhonchi. Initial laboratories were remarkable for leukocytosis and hypoxemia. The drug screen test was negative. Chest radiograph showed multiple nodular densities distributed in both lungs and alveolar infiltrates with air bronchograms in the right upper lobe. Chest computerized tomography revealed diffuse patchy opacities and ground glass bilaterally. Respiratory therapies and empirical antibiotics were started. The next day, the patient's symptoms markedly improved, including shortness of breath, hypoxemia, and hemoptysis. Cultures and tuberculosis workup came back negative. After the complete amelioration of symptoms, the patient admitted to consuming cocaine the day the symptoms began and related it to his inhaled intake. A Follow-up chest x-ray showed resolution of previously visualized diffuse patchy pulmonary opacities. DISCUSSION: Crack-lung is an acute pulmonary syndrome induced by cocaine, characterized by diffuse alveolar damage and hemorrhagic alveolitis that occurs within 48 hours after its consumption. Diagnosis can be challenging since it can mimic many diseases, so it is essential to consider those patients with a history of drug abuse who come to the emergency room. Its incidence is still unknown. Laboratory tests are nonspecific, and negative toxicology tests do not rule out this disease. Diagnosis requires a temporal relationship of cocaine use within 48 hours of symptom onset, radiological evidence, and a consistent clinical course. REFERENCE #1: Forrester JM, Steele AW, Waldron JA, Parsons PE. Crack lung an acute pulmonary syndrome with a spectrum of clinical and histopathologic findings. Am Rev Respir Dis. 1990;142(2):462–467. doi:10.1164/ajrccm/142.2.462 DISCLOSURES: No relevant relationships by Gabriela Negron-Ocasio, source=Web Response No relevant relationships by Nicole Rassi, source=Web Response No relevant relationships by William Redondo, source=Web Response No relevant relationships by Nicole Rivera-Bobe, source=Web Response No relevant relationships by JORGE SANDELIS PEREZ, source=Web Response No relevant relationships by Juan Santiago, source=Web Response