Shafi M I, Liaquat S, Auckley D
Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Respir Med Case Rep. 2018 Jun 4;25:22-24. doi: 10.1016/j.rmcr.2018.05.028. eCollection 2018.
Diffuse alveolar hemorrhage (DAH) can be a serious and life threating condition. Illicit substance use has been associated with DAH, with cocaine being the most widely reported. Marijuana use has been associated with pulmonary complications in the form of pneumomediatsium, pneumothorax, bullous disease, and pulmonary aspergillosis. We present a case of diffuse alveolar hemorrhage (DAH) resulting from marijuana inhalation, a finding rarely described in the literature. A 21-year-old male presented with several episodes of hemoptysis after drinking alcohol and smoking marijuana. He reported smoking 5-8 joints per day of marijuana (he denied use of bongs or other inhalant aids). His respiratory exam revealed bilateral fine rales. Laboratory evaluation included leukocytosis with left shift, normal platelets, coagulation profile, and a urine toxicology screen positive for tetrahydocanabinoid (THC). Chest CT revealed bilateral diffuse alveolar infiltrates suggestive of DAH. A bronchoscopy with BAL of bilateral upper lobes consistent with DAH with negative microbiologic studies, hemosiderin laden macrophages were present. Additional workup included a normal Echocardiogram, negative autoimmune serologies. His hemoptysis resolved with supportive care. DAH is a potentially fatal disease that has been associated with illicit substance use, most commonly cocaine. Recently, reports have surfaced associating marijuana use with DAH, though these cases have all involved the use of bongs or other inhalant aids, leading to the hypothesis that combustibles and inhaled particles may be the etiologic factor. This is the second report of DAH developing after smoking only marijuana, though the etiology for the association between marijuana use and DAH remains uncertain.
弥漫性肺泡出血（DAH）可能是一种严重的、危及生命的疾病。非法药物使用与DAH有关，其中可卡因的报道最为广泛。吸食大麻已被证实与多种肺部并发症有关，如纵隔积气、气胸、大疱性疾病和肺曲霉菌病。我们报告一例因吸入大麻导致的弥漫性肺泡出血（DAH）病例，这一发现鲜有文献报道。一名21岁男性在饮酒和吸食大麻后出现多次咯血。他自述每天吸食5 - 8支大麻烟（否认使用水烟筒或其他吸入辅助工具）。其呼吸检查显示双侧有细湿啰音。实验室检查包括白细胞增多伴核左移、血小板正常、凝血指标正常，尿液毒理学筛查四氢大麻酚（THC）呈阳性。胸部CT显示双侧弥漫性肺泡浸润，提示DAH。双侧上叶支气管肺泡灌洗术（BAL）结果与DAH相符，微生物学检查阴性，可见含铁血黄素巨噬细胞。进一步检查包括超声心动图正常、自身免疫血清学检查阴性。经支持治疗后，他的咯血症状得到缓解。DAH是一种潜在致命的疾病，与非法药物使用有关，最常见的是可卡因。最近，有报道称吸食大麻与DAH有关，不过这些病例均涉及使用水烟筒或其他吸入辅助工具，由此提出一种假设，即燃烧物和吸入颗粒可能是病因。这是第二例仅吸食大麻后发生DAH的报告，尽管大麻使用与DAH之间关联的病因仍不明确。
