Pneumotox » Drug » Marijuana, cannabis (haschish, hash, bang, dab)

Marijuana, cannabis (haschish, hash, bang, dab)

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Some adverse effects of marijuana may overlap with those of tobacco smoke. Not all studies confirmed whether marijuana per se is harmful to the airways (PMID 29629404). Variation in cannabis/marijuana/haschich potency, concentration (e.g. resin, hash oil), contamination with fungi (PMID 6348548) and possible adulteration should be considered (PMID:18494838). Reviews at PMID 24831571, 24897085, 25996274, 26935046, 29629404, 29971337. Some users vaporize cannabis using electronic cigarette devices (PMID 30835796)

Last update : 06/03/2019

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

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

I.e Acute eosinophilic pneumonia (AEP)

1

I.j Exogenous lipoid pneumonia (subacute, acute)

1

I.n Pulmonary alveolar proteinosis (PAP)

1

I.t Pneumoconiosis (silicosis, talcosis...)

1

I.an Hypersensitivity pneumonitis pattern

1

I.ao Pulmonary infiltrates

1

II.b ARDS - Acute lung injury

1

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

1

III.c Hemoptysis

1

IV.d Cough (lone)

1

V.f Pneumothorax

2

V.ab Pneumothorax, bilateral

1

VII.h Pneumomediastinum

5

VIII.w Uvulitis, uvular edema

1

IX.d Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

1

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

2

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

1

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

1

XI.m Pulmonary emphysema - Lung cysts or bullae

1

XI.s Sniffing death - Death from inhalation of compound

1

XI.av Deterioration of graft function in SOT recipients

1

XII.c Pericardial effusion (w/wo tamponade)

1

XII.d Myocarditis (can be fulminant)

1

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

1

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

1

XII.s Heart block (bundle branch- or AV-)

1

XII.w Asystole

1

XII.af Coronary vasospasm - Vasospastic angina

1

XII.ap Coronary artery dissection

1

XIII.a Lung cancer

3

XV.k Path: Desquamative interstitial pneumonia (DIP-pattern)

1

XV.n Path: Pulmonary alveolar proteinosis pattern (PAP pattern)

1

XV.p Path: Exogenous lipoid pneumonia

1

XV.q Path: Foreign body deposits/granulomatous reaction

1

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

1

XV.v Path: Micronodular organizing pneumonia/BOOP

1

XVI.ai Imaging: A 'tree-in-bud' pattern

1

XVII.a Respiratory tract infection incl. pneumonia

1

XVII.c Aspergillosis, pulmonary (invasive, allergic [ABPA], or mycetoma)

2

XVII.g Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

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

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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