Abstract Introduction Amphetamine use can cause diffuse vasospasm, leading to pulmonary hemorrhage, ARDS, and RCVCS. Early diagnosis and supportive care are crucial. Case Report A 30-year-old male with schizophrenia presented to the ED with cough and dyspnea after smoking flavored tobacco (hookah). He was hypoxic, tachycardic, and in respiratory distress with bibasilar crackles. He was intubated, with blood noted in the endotracheal tube. CT chest showed diffuse bilateral ground-glass opacities without PE. Echo revealed new severe LV hypokinesis (EF 10%), and ECGs showed sinus tachycardia. Drug screening confirmed amphetamines and THC. Ventilation was initiated per ARDS protocol along with nebulized tranexamic acid for hemoptysis. He suffered a brief PEA arrest post-intubation and underwent 24 hours of targeted temperature management (TTM). Neuroimaging revealed a small subarachnoid hemorrhage, cerebellar infarct, and multifocal diffuse intracranial vasospasm. Cerebral angiography confirmed reversible cerebral vasoconstriction syndrome (RCVS), treated with intra-arterial then oral verapamil. His condition improved, and he was eventually extubated and discharged to psychiatry. At 1-year follow-up, he remains functional and asymptomatic. Discussion Amphetamines can induce excessive catecholamine release, leading to diffuse vasospasm, endothelial injury, vascular permeability and tissue hypoxia across multiple organ systems; The lungs (ARDS, pulmonary hypertension and DAH), heart (arrhythmias, stress cardiomyopathy, vasospastic angina), eyes (transient monocular blindness, retinal occlusion), kidneys (renal tubular injury), and brain (RCVCS, ischemic and hemorrhagic stroke). The condition is rare but increasingly reported in males under 45 with polysubstance use (as in our case). ARDS from Amphetamine induced pulmonary hemorrhage is uncommon, with few reported cases. Reversible Cerebral Vasoconstriction Syndrome (RCVCS) is exceedingly rare (0.2 cases per million annually), characterized by transient narrowing of cerebral arteries. Though more common in females, amphetamine-associated cases are increasingly recognized amongst males. Diagnostic criteria includes severe (thunderclap-type) headaches, seizures, and/or focal deficits following drug exposure, with imaging showing ischemic or hemorrhagic changes. Digital Subtraction Angiography (DSA) is the gold standard, revealing alternating segments of arterial narrowing and dilation (string of beads appearance). The RCVS2 score incorporates clinical and imaging findings to help rule out other intracranial vasculopathies; a score of ≥ 5 is both highly specific and sensitive. Treatment includes calcium channel blockers such as verapamil, with 90% reported recovery and reversibility demonstrated on angiography within 1-3 months (a key feature). Our patient’s outcome underscores the importance of early recognition of drug-induced vasospasm, management within a multidisciplinary team with interventional capability, and the implementation of supportive care to maintain systemic perfusion. This abstract is funded by: None
Sharma et al. (2026) studied this question.