C48-33 Meth and Breath: When Stimulants Strike the Lungs

Abstract Introduction Amphetamines are associated with a range of acute and chronic pulmonary complications. Acute effects can include pulmonary edema, acute respiratory distress syndrome (ARDS), alveolar hemorrhage, and pneumonitis. Pneumonitis specifically induced by amphetamine use is rarely reported. We describe a case of pneumonitis resulting from the inhalation of amphetamines. Description of actual case report A 43-year-old female presented with rapidly progressive shortness of breath and cough for one week. A CT scan of the chest demonstrated apical basilar gradient, diffuse ground-glass opacities suggestive of ARDS. She reported methamphetamine use within the past week, along with more remote vaping, which preceded the worsening of her respiratory symptoms. On admission, she required BiPAP for hypoxic respiratory failure and was initiated on empiric intravenous antibiotics. Laboratory studies revealed elevated inflammatory markers (ESR 89 mm/hr, CRP 31.3 mg/L) and LDH 710 U/L. Urine toxicology was positive for methamphetamine. Serial Bronchoalveolar lavage (BAL) was negative for diffuse alveolar hemorrhage, and the differential was 49% neutrophils; infectious and autoimmune evaluations were negative. Based on the clinical presentation and exclusion of other causes, a diagnosis of amphetamine-induced pneumonitis was made. She was treated with 240mg intravenous methylprednisolone and supportive care, resulting in rapid clinical improvement. The patient was successfully weaned off supplemental oxygen and discharged on an oral steroid taper with pulmonology follow-up. Discussion of novelty and importance Amphetamine-induced pneumonitis is a rare but recognized pulmonary complication associated with stimulant abuse. The risk is particularly high among individuals who use amphetamines via inhalational or intravenous routes. The proposed mechanism of lung injury involves direct toxic effects, resulting from the generation of reactive oxygen species and free radicals, which lead to oxidative stress and inflammation. Clinically, the spectrum of presentation ranges from mild pneumonitis to severe manifestations such as acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage. Most patients exhibit significant improvement with supportive care and corticosteroid therapy. However, chronic or repeated exposure to amphetamines can result in persistent interstitial inflammation, ultimately progressing to interstitial lung disease and pulmonary fibrosis. Conclusion Amphetamine-induced pneumonitis is a rare but serious pulmonary complication that can progress to respiratory failure if unrecognized. Early identification with rapid exclusion of alveolar hemorrhage, cessation of drug use, and supportive care, including steroids, is key to favorable outcomes. This abstract is funded by: none