The Crack Lung – A Case Report
Article Sidebar
Main Article Content
Abstract
Cocaine is an alkaloid extracted from the leaves of Erythroxylon coca and was first isolated in 1859. Cocaine induces both acute and chronic toxicity, affecting virtually every organ system. A 32-year-old male patient, with a history of post-traumatic epilepsy and substance abuse involving cannabinoids and cocaine, presented to the Emergency Department (ED) following self-limited seizures. Arterial blood gas analysis revealed hypoxemic respiratory failure, while blood tests showed no significant abnormalities. A thoracic computed tomography (CT) scan demonstrated extensive consolidations in most of the lower, middle, and upper pulmonary lobes. Transthoracic ultrasound suggested signs of non-compacted cardiomyopathy, and pulmonary ultrasound revealed a B-line pattern bilaterally. The patient was admitted to the Intensive Care Unit (ICU), due to respiratory insufficiency requiring invasive ventilation. Over time, his respiratory failure progressively improved, allowing extubation on the eighth day of hospitalization. He was discharged after two weeks and referred for follow-up consultations in Neurology, Psychiatry, and Cardiology. A follow-up CT scan performed three weeks after discharge showed resolution of the pulmonary consolidations and ground-glass opacities. Furthermore, a cardiac magnetic resonance imaging (MRI) study conducted five weeks post-discharge ruled out non-compacted cardiomyopathy. Cocaine-induced lung alterations are diverse and often nonspecific, making their diagnosis reliant on thorough clinical and radiological correlation. In this case, pulmonary parenchymal changes observed on the CT scan and severe respiratory failure raised suspicion for crack lung. Other potential diagnoses, such as cardiogenic and neurogenic pulmonary edema, were excluded.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Stolberg VB. The use of coca: prehistory, history, and ethnography. J Ethn Subst Abuse. 2011 Apr;10(2):126-46. doi:10.1080/15332640.2011.573310.
Tella SR, Schindler CW, Goldberg SR. Cardiovascular effects of cocaine in conscious rats: relative significance of central sympathetic stimulation and peripheral neuronal monoamine uptake and release mechanisms. J Pharmacol Exp Ther. 1992 Aug 1;262(2):602-10.
Smith JA, Mo Q, Guo H, Kunko PM, Robinson SE. Cocaine increases extraneuronal levels of aspartate and glutamate in the nucleus accumbens. Brain Res. 1995 Jun 19;683(2):264-9. doi:10.1016/0006-8993(95)00383-2.
Lange RA, Cigarroa RG, Yancy CW Jr, Willard JE, Popma JJ, Sills MN, et al. Cocaine-induced coronary-artery vasoconstriction. N Engl J Med. 1989 Dec 7;321(23):1557-62. doi:10.1056/NEJM198912073212301.
Kolodgie FD, Wilson PS, Cornhill JF, Herderick EE, Mergner WJ, Virmani R. Increased prevalence of aortic fatty streaks in cholesterol-fed rabbits administered intravenous cocaine: the role of vascular endothelium. Toxicol Pathol. 1993 Sep-Oct;21(5):425-35. doi:10.1177/019262339302100501.
Maeder M, Ullmer E. Pneumomediastinum and bilateral pneumothorax as a complication of cocaine smoking. Respiration. 2003 Jul-Aug;70(4):407. doi:10.1159/000072905.
Ettinger NA, Albin RJ. A review of the respiratory effects of smoking cocaine. Am J Med. 1989 Dec;87(6):664-8. doi:10.1016/s0002-9343(89)80401-2.
Smollin CG, Hoffman RS. Cocaine. In: Goldfrank's Toxicologic Emergencies. 11th ed. Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LS, Hoffman RS, editors. New York: McGraw Hill; 2019. p. 1124.
Lee HS, LaMaute HR, Pizzi WF, Picard DL, Luks FI. Acute gastroduodenal perforations associated with use of crack. Ann Surg. 1990 Jan;211(1):15-7. doi:10.1097/00000658-199001000-00003.
Novielli KD, Chambers CV. Splenic infarction after cocaine use. Ann Intern Med. 1991 Feb 1;114(3):251-2. doi:10.7326/0003-4819-114-3-251.
Edmondson DA, Towne JB, Foley DW, Abu-Hajir M, Kochar MS. Cocaine-induced renal artery dissection and thrombosis leading to renal infarction. WMJ. 2004;103(7):66-9.
Flaque-Coma J. Cocaine and rhabdomyolysis: report of a case and review of the literature. Bol Asoc Med P R. 1990 Sep;82(9):423-4.
Libman RB, Masters SR, de Paola A, Mohr JP. Transient monocular blindness associated with cocaine abuse. Neurology. 1993 Jan;43(1):228-9. doi:10.1212/wnl.43.1_part_1.228-a.
Midthun KM, Nelson LS, Logan BK. Levamisole—a toxic adulterant in illicit drug preparations: a review. Ther Drug Monit. 2021 Apr;43(2):221-8. doi:10.1097/FTD.000000000000085.
Oliva F, Mangiapane C, Nibbio G, Berchialla P, Colombi N, Vigna-Taglianti FD. Prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Psychiatr Res. 2021 Nov;143:587-98. doi:10.1016/j.jpsychires.2020.11.021.
Weiford B, Subbarao V, Mulhern K. Noncompaction of the ventricular myocardium. Circulation. 2004 Jun 22;109(24):2965-71. doi:10.1161/01.CIR.0000132478.60674.D0.
Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008 Mar;155(3):408-17. doi:10.1016/j.ahj.2007.11.008.
Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007 Apr;51(4):447-55. doi:10.1111/j.1399-6576.2007.01276.x.
Almeida RR, Zanetti G, Souza AS Jr, et al. Cocaine-induced pulmonary changes: HRCT findings. Braz J Pneumol. 2015 Jul-Aug;41(4):323. doi:10.1590/S1806-37132015000000025.
Giacomi FD, Srivali N. Cocaine use and crack lung syndrome. QJM. 2019 Feb;112(2):125-6. doi:10.1093/qjmed/hcy255.
Greenberg A, Stammers K, Moonsie I, Jose RJ. All puffed out—a case of crack lung. Clin Med. 2017 Apr;17(2):186-7. doi:10.7861/clinmedicine.17-2-186.
Gorelick DA. Testing for substances of abuse. In: American Psychiatric Association Publishing Textbook of Substance Use Disorder Treatment. 6th ed. Brady KT, Levin FR, Galanter M, Kleber HD, editors. Washington (DC): American Psychiatric Association; 2021.