C48-25 Pipe Dreams and Pulmonary Nightmares: A Case of Crack Lung

Abstract Introduction Crack lung is an acute pulmonary syndrome associated with the inhalation of crack cocaine, a freebase form of cocaine that is smoked for rapid onset of euphoria. The direct exposure of the lung to volatilized cocaine and combustion byproducts leads to a spectrum of pulmonary complications, including diffuse alveolar damage, hemorrhage, interstitial pneumonitis, and barotrauma. The syndrome is characterized by acute onset of respiratory symptoms like dyspnea, cough, hemoptysis, and hypoxemia, accompanied by radiographic findings of bilateral infiltrates. The increasing prevalence of crack cocaine use has made crack lung a significant concern in emergency and pulmonary medicine, with both acute and chronic respiratory sequelae reported among habitual users. Case Presentation A 35-year-old male with a history of polysubstance abuse presented to the hospital with chest pain and hemoptysis. He had been smoking crack cocaine earlier in the day and became unresponsive. His friends administered naloxone and performed chest compressions. He initially denied ambulance transport to the hospital. Family later brought him into the emergency room when he began experiencing chest pain and hemoptysis. He was hypoxic, requiring 8 L nasal cannula. CT angiography of the chest demonstrated diffuse bilateral ground-glass opacities. Urine drug screen confirmed the presence of cocaine and cannabinoids. While in the hospital, he did have additional, witnessed hemoptysis. The patient was treated with high-dose corticosteroids and antibiotics. Chest X-ray the following day demonstrated complete resolution of the bilateral lung opacities. Infectious workup remained negative, and antibiotics were discontinued. Corticosteroids were changed from intravenous to oral. Hemoptysis resolved, and the patient was discharged home Discussion The pathogenesis of crack lung involves direct toxic injury to the alveolar-capillary membrane, resulting in increased permeability, alveolar hemorrhage, and inflammatory responses. Imaging typically reveals bilateral infiltrates, ground-glass opacities, and in some cases, barotrauma or pneumothorax. Management is primarily supportive. Corticosteroids have been used in severe cases, although evidence for their efficacy is limited. Recognition of crack lung is critical, as the diagnosis relies on a high index of suspicion in patients with compatible clinical and radiologic findings and a history of crack cocaine use. The overlap with other inhalational injuries and confounding factors such as tobacco and marijuana use complicates attribution of symptoms solely to crack cocaine. Increased awareness and reporting of crack lung cases are essential for improving understanding and guiding management of this unique drug-induced lung injury. This abstract is funded by: none