Acute pulmonary injury after inhalation of free-base cocaine: A case report

Laura J. Bontempo, Phillip Magidson, Bryan D. Hayes, Joseph P. Martinez

Research output: Contribution to journalArticle

Abstract

Introduction: Many patients presenting to urban emergency departments (EDs) have chief complaints directly related to the use of illicit drugs. Given the reluctance of patients to admit to their use of cocaine, it is important for the emergency medicine provider (EMP) to recognize key epidemiologic principles as well as features of the history, physical examination, and diagnostic studies that suggest the sequelae of cocaine abuse. Case Presentation: We describe our assessment of an otherwise healthy 47-year-old man with the acute onset of pleuritic chest pain accompanied by hypoxia, radiographic evidence of diffuse alveolar hemorrhage (DAH), and an elevated creatine phosphokinase (CPK) level. The patient vehemently denied active cocaine abuse. No clear pulmonary, cardiac, or infectious explanations for his signs and symptoms were readily apparent. Ultimately, after further workup and urine toxicology screening, the cause of this patient's chest pain and hypoxia was determined to be DAH related to his recent inhalation of crack cocaine. The patient was treated with systemic corticosteroids and improved. Conclusion: Nearly 41% of patients who present to the ED because of complications of inhaled cocaine use are experiencing pleuritic chest pain, and more than half have an elevated CPK concentration. As many as 40% of these patients deny using the drug when asked. These data are important for EMPs to know when formulating a differential diagnosis for patients presenting with pleuritic chest discomfort.

Original languageEnglish (US)
Pages (from-to)82-86
Number of pages5
JournalJournal of Acute Medicine
Volume7
Issue number2
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

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Acute Lung Injury
Cocaine
Inhalation
Chest Pain
Cocaine-Related Disorders
Creatine Kinase
Hospital Emergency Service
Crack Cocaine
Hemorrhage
Emergency Medicine
Street Drugs
Toxicology
Signs and Symptoms
Physical Examination
Adrenal Cortex Hormones
Differential Diagnosis
Thorax
History
Urine
Lung

Keywords

  • Chest pain
  • Cocaine
  • Inhalation injury
  • Pulmonary disease

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Acute pulmonary injury after inhalation of free-base cocaine : A case report. / Bontempo, Laura J.; Magidson, Phillip; Hayes, Bryan D.; Martinez, Joseph P.

In: Journal of Acute Medicine, Vol. 7, No. 2, 01.06.2017, p. 82-86.

Research output: Contribution to journalArticle

Bontempo, Laura J. ; Magidson, Phillip ; Hayes, Bryan D. ; Martinez, Joseph P. / Acute pulmonary injury after inhalation of free-base cocaine : A case report. In: Journal of Acute Medicine. 2017 ; Vol. 7, No. 2. pp. 82-86.
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