Take a crack at Crack Lung!

A 55yo M presenting with cough, hemoptysis, shortness of breath and wheezing less than 24 hours after smoking “crack” or modified cocaine. The differential diagnosis included amongst many other things, Crack Lung or Acute Pulmonary Toxicity from inhalation (smoking/snorting) of cocaine.

Learning points:

– acute lung injury from cocaine happens usually with use within 48 hrs of symptoms

– acutely, in addition to crack lung other processes can also happen like acute eosinophilic pneumonia, pneumo- thorax/mediastinum/pericardium, pulmonary vascular processes

– on the street cocaine is modified by boiling in baking soda and distilling it to make crack/ “rock” which makes the compound heat stable and allows it to be smoked; cleanliness/ awareness needed with the smoking pipes (HCV transmission was noted to be higher in patients sharing broken pipes which often cut lips)

– management of eosinophilic PNA and crack lung is very different as the former onvolves systemic steroids and therefore  needs to be determined in some cases with borncho-alveolar lavage

This paper is a comprehensive review on pulmonary complications of cocaine published in the Chest.