Table 2. Clinical Features of Acute Lung Injury After Smoking Crack Cocaine

Age/Sex [Ref]

Onset after smoking

Other drugs used

Symptoms

Hemoptysis

T >38 degrees

Blood eos >5%

Chest film

Treatment

1. 32/M [25]

10 da intermittent use

Cigarettes, marijuana

Non-productive cough, dyspnea

No

Yes

No

Small, bilateral nodules

Ventilation, antibiotics, bronchodilators, prednisone

2. 47/F [19]

1 week intermittent use

Cigarettes, 1-3 ppd

Dyspnea, productive cough

Yes, during 3rd episode

Yes

Yes

Patchy, bilateral, alveolar opacities

Antibiotics, bronchodilators, steroids during 2nd & 3rd episodes

3. 23/F [22]

2 h

Cigarettes, 1 ppd, past IVDA*

Dyspnea, cough

Yes

Yes

No

Diffuse, bilateral, alveolar opacities

Antibiotics, ventilation, transfusion, steroids

4. 25/F [22]

1 h

Cigarettes, 1 ppd, marijuana

Cough, chest pain, confusion, dyspnea

Yes

Yes

No

Diffuse, bilateral, alveolar opacities

Antibiotics, ventilation, steroids

5. 27/M [26]

Unknown

Cigarettes, 1 1/2 ppd

Cough, purulent sputum, wheeze, dyspnea

No

No

Yes

Diffuse, interstitial opacities

Bronchodilators, oxygen, prednisone after 3 wks

6. 16/M [27]

Smoked cocaine 5 da before admission

Cigarettes, 1 ppd

Productive cough, chest pain, nausea

No

Yes

Yes

Diffuse, alveolar & interstitial opacities, bilateral small pleural effusions

Antibiotics, ventilation

*IVDA = intravenous drug abuse

Discussion

Table 3. Biopsy Results

Days after onset of symptoms/Type

Results

Treatment/Outcome

1. 14 da/Open

Bronchiolar and peribronchiolar air space granulation tissue with lymphoid cells, eosinophils, PMNs, & fibrinous exudate

Steroids discontinued over 6 mo. Mild obstruction with normal chest radiograph at 18 mo

2. 4-6 da/TBB*

Mild interstitial pneumonia with type II hyperplasia, interstitial lymphoid cells, rare eosinophils, PMNs. BAL fluid showed eosinophils and Charcot-Leyden crystals

Steroids begun 6 da post biopsy. Patient asymptomatic with clear chest radiograph 2 wks after discharge

3. 8 da/Open

Organizing alveolar damage, hemosiderin-laden alveolar macrophages, eosinophils, PMNs, lymphoid cells. Hyaline membranes

Rapid improvement on steroids. Extubated postoperative da 3 and radiograph cleared by da 14

4. 3 da/TBB

Hemosiderin-laden macrophages, hyaline membranes. Interstitial pneumonia with lymphoid cells, eosinophils, and PMNs. Hyperplastic type II cells

Steroids permitted extubation on postoperative da 3. Chest radiograph clear at 5 wks

5. >7 da/TBB

Normal lung parenchyma, eosinophils in bronchial wall

Symptoms and radiograph cleared after 2 1/2 wks of steroids

6. 12 da/Bronchial wash

Eosinophils 67%, some PMNs

Rapid improvement on steroids

*TBB = transbronchial biopsy

Discussion