Alveolar hemorrhage associated with cocaine consumption

Abstract

Cocaine is an illegal drug; its abuse and toxicity are a public health problem due to its high morbidity and mortality. Cocaine can affect the cardiovascular, central nervous and respiratory systems. The case of a 42-year-old male without history of chronic or degenerative diseases, but previous cocaine consumption is presented in this report. The patient is admitted to the Emergency Department given that the clinical presentation included hemoptysis and dyspnea with mild to minimal activity, which evolved to orthopnea. Advanced airway management was required and supportive care at the Intensive Care Unit was provided. Imaging studies showed evidence compatible with alveolar hemorrhage diagnosis. In search of an autoimmune etiology, an antibody-screening panel was requested, reporting negative results for autoimmune disorders. The patient management was based on corticosteroid therapy and plasmapheresis to counter the persistent hemoptysis and hemoglobin serum level decline. The management strategy was based on the clinical suspicion of vasculitis and a torpid clinical evolution. Pulmonary sepsis ensued, resulting in patient's death. The necropsy report describes the primary cause of death as diffuse alveolar hemorrhage secondary to diffuse alveolar injury. This case report presents the detailed clinical, imagining and histopathological findings of a patient with alveolar hemorrhage secondary to cocaine consumption, as well as a review of the literature.

Managing and securing the bleeding upper airway: a narrative review

“…Oral 75 or nasal 76 intubation, application of facemask (facial trauma) 77 Nasal or alveolar bleeding 78 123 drug-soaked cotton pledgets 31 for uncontrolled airway bleeding.…”

Força muscular respiratória e periférica, função pulmonar, ansiedade e depressão em dependentes quí­micos

“…A função pulmonar nesses indivíduos, apesar de alguns estudos não apontarem nenhum tipo de alteração significativa indicando consequências pelo uso de drogas, outros autores demostraram que os danos pulmonares são consequências do tempo de exposição, do tipo de substância utilizada e de comorbidades desenvolvidas ao longo dos anos [19]. Alguns estudos sugerem que a tosse seca, hemoptoica ou com escarro escuro, dor torácica, dispneia, sibilância, febre e infiltrado alveolar difuso ocorrem de forma aguda logo após a inalação do crack, pois os pulmões são os primeiros órgãos a serem expostos aos agentes químicos dessa droga [20,21].…”

Cocaine-induced pulmonary complications

“…[ 1 ] While cocaine-associated diffuse alveolar hemorrhage is relatively common, focal alveolar hemorrhage (FAH) is only reported in isolated cases without true numbers regarding prevalence. [ 2 3 4 5 ] Although FAH may mimic malignancy on imaging, this case illustrates the importance of follow-up and re-evaluation before taking biopsy for benign etiologies. Upon re-evaluation, rapid growth and eventual resolution of the lesion is apparent.…”

“…[ 6 ] Cessation of cocaine, oxygenation, and glucocorticoids remain the mainstay management of cocaine-induced alveolar hemorrhage. [ 4 ]…”