Transcript Document

Interstitial Pulmonary Fibrosis In An HIV Positive Person With
Surreptitious Long-standing Inhalation Of Crack Cocaine
Nikhil Madan M.D, Michael L. Scharf M.D
Thomas Jefferson Hospital, Philadelphia PA
INTRODUCTION
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Acute lung injury following crack
cocaine inhalation has been well
reported. Interstitial lung disease after
chronic cocaine inhalation is
uncommon.
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HISTORY
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A 39 year-old HIV positive lady with CD
4 counts > 200 on HAART therapy,
presented with worsening dyspnea for
about 2 weeks.
She was recently treated for Legionella
pneumonia confirmed by a urine
antigen.
Further history revealed progressive
dyspnea with oxygen dependence and
multiple steroid treatments for
“asthma”
10 pack year smoker but denied used
of recreational drugs.
On exam she was tachypneic hypoxic
and had diffuse bilateral crackles.
Pa02 was 56 mm Hg on blood gas
CT scan showed ( see figure 1 )
DISCUSSION
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Figure 1 : CT scan Chest showing multiple
cystic lucencies with some scarring and
septal thickening.
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Bronchoalveolar lavage from the
right middle lobe was negative for
PCP, fungi, bacteria
For a definitive diagnosis patient
underwent VATS lung biopsy which
showed ( see figure 2)
Figure 2 : Lung biopsy showing
interstitial pneumonitis,
fibrosis and granulomas –
Crack Lung
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Based on these findings the
physician returned to the
patient who admitted to
smoking crack cocaine for
several years without any
intravenous drug use.
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Interstitial lung disease is a rare
manifestation of smoking crack cocaine.
Like in our case it occurs after several years
of smoking.
It continues to progress despite quitting
smoking cocaine.
Response to corticosteroids and
immunosuppressive therapy is poor.
Legionella pneumonia may have been the
cause of her acute illness, but did not
explain her progressive oxygen-dependent
respiratory disease .
This case also demonstrates the importance
of patient-doctor communication at arriving
at the proper diagnosis and alerts physicians
to include long-term crack cocaine
inhalation as a cause of advanced lung
disease.
REFERENCES
1.T he pulmonary complications of crack cocaine: a
comprehensive review. Chest 1995;107: 233–240.
2. Interstitial pneumonitis associated with “crack” cocaine
abuse. Chest 1991;100:1155–1157.
3. Pulmonary status of habitual cocaine smokers. Am Rev
Resp Dis 1992;145:92–100.