Crack Lung: A Clinical Diagnosis

IntroductionCrack lung is a clinically diagnosed form of diffuse alveolar hemorrhage that occurs acutely within 48 hours of smoking crack cocaine. The diagnosis of crack lung is based on history, clinical presentation, laboratory, and radiographic findings. Unlike most other forms of alveolar hemorrhage, crack lung does not require extensive or invasive work up and is managed symptomatically. We hereby present a case of acute diffuse alveolar hemorrhage secondary to crack cocaine which was clinically diagnosed and managed symptomatically. Case reportPatient was a 46-year-old female with a past medical history of type II diabetes mellitus, chronic obstructive pulmonary disease and polysubstance abuse that was brought to the emergency room after she was found unresponsive. 4mg of Narcan was administered and she became alert. Following Narcan administration, patient remained altered and confused. At the emergency room patient endorsed shortness of breath at rest which she associated it with a prior COVID-19 pneumonia one month ago. Vital signs were significant for a Temperature:99.2 blood pressure: 130/66, heart rate: 125, respiratory rate:27, Oxygen saturation: 95% on non-rebreather at 15L/min. Laboratory investigations were significant elevated creatinine (1.38, baseline unknown);white blood cell count (30.25), arterial blood gas was reported as 7.26/45/69 on 100%. Serum troponin was elevated at 3.12. Electrocardiogram showed sinus tachycardia, chest x-ray showed diffuse bilateral patchy airspace disease, computed tomography of the chest showed bilateral diffuse lung consolidation with small ground glass opacities (figure 1). Computed tomography of the head showed no acute intracranial process and urine drug screen was positive for cocaine. Patient was started on 4 mg of Narcan, 125 mg of methylprednisolone and transferred to the medical intensive care unit (MICU). In the MICU, blood, sputum and urine culture were obtained. Pt was empirically managed on vancomycin and piperacillin-tozabactam. Because of diffuse alveolar hemorrhage was in the differential, patient was continued on 80 mg of IV methylprednisolone every 8 hours. Patient was observed in the unit for 2 days. During stay in the MICU, repeat chest x-ray showed improvement in lung opacities bilaterally. Vitals were within normal range. Patient was weaned down from non-rebreather to 2 Liters of oxygen and then transferred to the general floor. ConclusionPatients with crack lung often present with shortness of breath, fever, cough with or without hemoptysis and sometimes hypoxemia within 48 hours of insult. Early diagnosis based on history, physical examination, laboratory and radiographic findings can ensure prudent management.