Forrester J M, Steele A W, Waldron J A, Parsons P E
University of Colorado Health Science Center, Division of Pulmonary Sciences, Denver 80262.
Am Rev Respir Dis. 1990 Aug;142(2):462-7. doi: 10.1164/ajrccm/142.2.462.
In this report, we review the hospital course of four patients who presented with an acute pulmonary syndrome after inhaling freebase cocaine and compare them with previously described case reports. Two patients had prolonged inflammatory pulmonary injury associated with fever, hypoxemia, hemoptysis, respiratory failure, and diffuse alveolar infiltrates. Lung tissue specimens from both patients revealed diffuse alveolar damage, alveolar hemorrhage, and interstitial and intraalveolar inflammatory cell infiltration notable for the prominence of eosinophils. Immunofluorescent staining performed on one of the biopsy specimens showed a striking deposition of IgE in both lymphocytes and alveolar macrophages. Both patients were treated with systemic corticosteroids and rapidly improved. In contrast, two patients presented acutely with diffuse pulmonary alveolar infiltrates associated with dyspnea and hypoxemia, but without fever, and within 36 h of discontinuing cocaine their pulmonary infiltrates and symptoms had spontaneously resolved. Our report further supports the finding that an acute pulmonary syndrome can occur after inhalation of freebase cocaine. Furthermore, the lung injury may respond to systemic corticosteroid therapy when it is associated with a prominent inflammatory cell infiltration.
在本报告中，我们回顾了4例吸入游离碱可卡因后出现急性肺综合征患者的住院病程，并将他们与先前描述的病例报告进行比较。2例患者出现与发热、低氧血症、咯血、呼吸衰竭及弥漫性肺泡浸润相关的持续性炎症性肺损伤。这2例患者的肺组织标本均显示弥漫性肺泡损伤、肺泡出血以及以嗜酸性粒细胞显著增多为特征的间质和肺泡内炎性细胞浸润。对其中1例活检标本进行的免疫荧光染色显示，淋巴细胞和肺泡巨噬细胞内均有明显的IgE沉积。这2例患者均接受了全身糖皮质激素治疗，病情迅速改善。相比之下，另外2例患者急性起病，表现为与呼吸困难和低氧血症相关的弥漫性肺泡浸润，但无发热，在停用可卡因36小时内，其肺部浸润和症状自行缓解。我们的报告进一步支持了吸入游离碱可卡因后可发生急性肺综合征这一发现。此外，当肺损伤伴有显著的炎性细胞浸润时，全身糖皮质激素治疗可能有效。
