Reichert Manuel, Holtz Tobias
Department of Internal Medicine III, St. Bernward's Hospital, Hildesheim, Lower Saxony, Germany.
Department of Radiology, St. Bernward's Hospital, Hildesheim, Lower Saxony, Germany.
AME Case Rep. 2025 Jul 2;9:81. doi: 10.21037/acr-24-283. eCollection 2025.
With the increasing use of inhaled drugs such as cocaine and amphetamines, drug-induced lung injury has become a relevant condition in emergency settings. "Crack lung" is a well-documented, acute pulmonary syndrome associated with inhalation of cocaine, characterized by respiratory distress, hemoptysis, and various radiographic findings. While the syndrome is more common among younger individuals, it can present in older patients, often triggered by the acute use of inhalative drugs.
A 60-year-old obese male with no significant history of lung or cardiac disease presented to the emergency department with sudden-onset dyspnea, severe hemoptysis, palpitations, and tachycardia. Vital signs indicated hypertension (180/110 mmHg) and hypoxia [peripheral capillary oxygen saturation (SpO) of 80% on room air]. The electrocardiogram (ECG) revealed sinus tachycardia but no right bundle branch block (RBBB). Laboratory tests were mostly unremarkable, and a computed tomography (CT) scan ruled out pulmonary embolism but showed diffuse bronchial wall thickening consistent with bronchitis or atypical pneumonia. During the clinical interview, the patient admitted to recent use of inhaled cocaine and amphetamines, leading to the diagnosis of early-stage "crack lung". After stabilization by administration of oxygen, bronchodilatators and prednisolone, the patient was discharged with follow-up care focusing on cessation of drug use and monitoring for potential lung damage. Bronchoscopically, there was no evidence of another cause of hemorrhage such as tumor growth.
This case highlights the importance of recognizing drug-induced lung injury in patients presenting with acute respiratory distress and hemoptysis. As the use of inhaled drugs such as cocaine continues to rise in Germany, awareness of conditions like "crack lung" is essential for timely diagnosis and management. Steroids may play a role in reducing inflammation, but further research is needed to establish standardized treatment protocols for this condition.
随着可卡因和苯丙胺等吸入性药物的使用日益增加，药物性肺损伤已成为急诊环境中的一种相关病症。“快克肺”是一种有充分文献记载的、与吸入可卡因相关的急性肺综合征，其特征为呼吸窘迫、咯血及各种影像学表现。虽然该综合征在年轻人中更为常见，但也可出现在老年患者中，常由急性使用吸入性药物引发。
一名60岁肥胖男性，无肺部或心脏疾病史，因突发呼吸困难、严重咯血、心悸和心动过速就诊于急诊科。生命体征显示高血压（180/110 mmHg）和低氧血症（室内空气下外周毛细血管血氧饱和度（SpO）为80%）。心电图（ECG）显示窦性心动过速，但无右束支传导阻滞（RBBB）。实验室检查大多无异常，计算机断层扫描（CT）排除了肺栓塞，但显示与支气管炎或非典型肺炎一致的弥漫性支气管壁增厚。在临床问诊过程中，患者承认近期使用过吸入性可卡因和苯丙胺，从而诊断为早期“快克肺”。在给予氧气、支气管扩张剂和泼尼松龙使其病情稳定后，患者出院，并接受以停止吸毒和监测潜在肺损伤为重点的后续护理。支气管镜检查未发现肿瘤生长等其他出血原因。
本病例突出了在出现急性呼吸窘迫和咯血的患者中识别药物性肺损伤的重要性。随着德国可卡因等吸入性药物的使用持续增加，认识“快克肺”等病症对于及时诊断和管理至关重要。类固醇可能在减轻炎症方面发挥作用，但需要进一步研究以建立针对该病症的标准化治疗方案。
