Exogenous Lipid Pneumonia Related to Smoking Weed Oil Following Cadaveric Renal Transplantation

Abstract

A 30-year-old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP) reaction and exogenous lipid pneumonia (ELP). The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. Physicians should be aware of the different forms of marijuana available and of their potential medical complications.

Marijuana medusa: The many pulmonary faces of marijuana inhalation in adolescent males

“…Acute respiratory failure is a common complication of inhalation drug abuse, most commonly from cocaine and amphetamines abuse . An increasing number of cases of respiratory failure from marijuana abuse have been reported in adults . The most common pulmonary injuries from marijuana inhalation are bronchospasm, pneumothorax, and aspergillus infection from contaminated inhalants .…”

Marijuana and Listing for Heart Transplant

“…33 There are also concerns specifically related to the immune suppression needed in the post-transplant patient population. Case reports have implicated marijuana use with ventricular tachycardia, 17 exogenous lipoid pneumonia, 18 and invasive aspergillosis 16,19 in immune suppressed patients, although the incidence of these cases is likely rare. These potential risks contradict the public's perception that marijuana is benign and in certain circumstances a healthful alternative medicine.…”

“…Next, although we stopped respondents from filling out the survey multiple times from the same device, we did not keep respondents from filling out the survey multiple times from different computers or forwarding the survey to colleagues, which could skew results. Despite these limitations, given the paucity of data on the safety of marijuana use after transplant and anecdotal reports showing potential harm in immune suppressed patients, [16][17][18][19] guidelines on the topic will rely on this type of information to establish community consensus.…”

“…14 There is no consensus within the transplant community about whether patients who actively use marijuana should be eligible for transplant listing. 4,15 Investigators have described adverse events potentially related to marijuana consumption after organ transplantation, [16][17][18][19] but there is a paucity of data on the outcomes of patients who used marijuana before transplant or safety data for marijuana use after transplantation. 4 To assess current practice patterns and attitudes toward marijuana use in their patients, we conducted an anonymous, web-based survey of healthcare providers in the heart and lung transplant community.…”

Denying renal transplantation to an adolescent medical cannabis user: An ethical case study

“…Although vaporization reduces the risk of inhaling smoke by‐products such as tar, it may expose the patient to lipid inhalation. There is one case report of a renal transplant patient who presented with exogenous lipid pneumonia which was considered to be secondary to inhaling the vapors of a cannabis, isopropyl alcohol, and oil‐based mixture that the patient had been using 2‐10 times a day for over 10 years . However, this a rare case of home‐prepared cannabis oil used frequently over many years, and it is unclear whether manufactured vaporization cannabis oils and delivery products carry the same risk.…”