Crack lung: a case report with diagnostic confirmation

Abstract Crack lung is an uncommon and potentially life-threatening entity resulting from the inhalation of freebase cocaine. It typically presents acutely with dyspnea, cough, hemoptysis and hypoxemia secondary to alveolar–capillary injury induced by the vasoconstrictive and cytotoxic effects of the substance. The condition can mimic infectious or inflammatory processes, delaying diagnosis and treatment.We report the case of a 36-year-old man with a history of chronic kidney disease and polysubstance abuse who presented with sudden-onset dyspnea and hemoptysis. Chest radiography revealed bilateral perihilar alveolar opacities, and High-Resolution Computed Tomography (HRCT) demonstrated ground-glass opacities consistent with diffuse alveolar hemorrhage. Bronchoalveolar lavage confirmed the presence of hemosiderophages, supporting the diagnosis of crack lung. Systemic corticosteroid therapy led to complete clinical and radiologic resolution.This case highlights the importance of considering drug exposure in young patients presenting with hemoptysis and diffuse pulmonary findings, as lack of toxicological testing or denial of drug use may lead to diagnostic errors. HRCT is essential for identifying alveolar hemorrhage patterns and excluding alternative causes, while bronchoalveolar lavage can provide diagnostic confirmation in uncertain cases. The favorable response to corticosteroids supports their therapeutic role in acute pulmonary injury induced by inhaled drugs.Early recognition of crack lung and awareness of its imaging spectrum are crucial for accurate differential diagnosis of diffuse alveolar hemorrhage syndromes and to prevent unnecessary interventions. This report contributes a case with complete diagnostic confirmation and favorable outcome, emphasizing the value of clinical, imaging, and toxicologic correlation in this rare pulmonary complication.