Gilbert O, Mathieu D, Hanquet O, Lardinois I, Cornut P, Pierard P, Van Meerhaeghe A
Services de pneumologie, CHU de Charleroi, Belgique.
Rev Mal Respir. 2006 Nov;23(5 Pt 1):471-6. doi: 10.1016/s0761-8425(06)71820-4.
We describe the development of severe and recurrent alveolar hemorrhage in a 30 year old man. The patient had presented with frank hemoptysis, that recurred after an interval of 4 weeks, associated with dyspnea and severe anemia requiring transfusion. The chest x-ray and CT scan showed bilateral diffuse ground glass shadows. Fibreoptic bronchoscopy confirmed bilateral diffuse bleeding. Investigations for the common causes of diffuse alveolar hemorrhage (immunological, infective) proved to be negative on two occasions. Toxicological examination of the urine during the relapse revealed a significant level of cannabis and a trace of cocaine. The patient repeatedly denied the use of illicit drugs.
Because of the general condition of this young patient a lung biopsy was performed by video-thoracoscopy. This showed evidence of diffuse alveolar damage compatible with inhalation of cocaine. Faced with these results the patient admitted that he regularly smoked "improved joints".
This clinical observation emphasises that the inhalation of cocaine is a cause of diffuse alveolar hemorrhage particularly in young adults.
