Pneumotox » Drug » Crack cocaine

Crack cocaine

See also under cocaine and levamisole, a common adulterant of cocaine from the 2000s. PMID 8874270, 1731605, 17620460, 24429586

Last update : 19/04/2014

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.e Acute eosinophilic pneumonia (AEP)

I.g Pulmonary fibrosis

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

II.j Transient pulmonary opacities/infiltrates (see also under Iav)

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

IV.a Bronchospasm - Wheezing - Asthma

IV.c Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)

IV.e Cough (acute, violent, explosive)

IV.f Severe or catastrophic bronchospasm or asthma attack (can be fatal)

V.b Eosinophilic pleural effusion

V.f Pneumothorax

V.x Black pleural effusion

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

VII.h Pneumomediastinum

VIII.a Angioedema (may cause UAO, asphyxia and death)

VIII.d Thermal (burns, frostbite), chemical or caustic injury on the face, mouth, tongue, pharynx or upper airway

VIII.m Drug foreign body in the airway

VIII.ac Retropharyngeal emphysema

VIII.ap Airway foreign body

X.ac Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

XI.b Chest pain (acute or subacute), lone or prominent

XI.c Pleuritic chest pain

XI.bp Lung herniation

XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.l Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

XII.aa Arterial (aorta, limb) vasoconstriction and/or ischemia, acute

XII.ae Aortic dissection

XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

XV.e Path: ILD with a granulomatous component (see also Im)

XV.g Path: Alveolar hemorrhage (see also IIIa)

XV.q Path: Foreign body deposits/granulomatous reaction

XV.s Path: Pneumoconiosis (silicosis, talcosis, talcoma)

XV.bb Path: Airway inflammation

XV.bj Path: Alveolar carbonaceous material or deposits

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

XVI.d Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XVI.k Imaging: An area or areas of consolidation

XVIII.l Eye catcher: Candy-cane esophagus

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France