Alveolar hemorrhage associated with cocaine consumption

Cocaine is an illegal drug; its abuse and toxicity are a public health problem due to its high morbidity and mortality. Cocaine can affect the cardiovascular, central nervous and respiratory systems. The case of a 42-year-old male without history of chronic or degenerative diseases, but previous cocaine consumption is presented in this report. The patient is admitted to the Emergency Department given that the clinical presentation included hemoptysis and dyspnea with mild to minimal activity, which evolved to orthopnea. Advanced airway management was required and supportive care at the Intensive Care Unit was provided. Imaging studies showed evidence compatible with alveolar hemorrhage diagnosis. In search of an autoimmune etiology, an antibody-screening panel was requested, reporting negative results for autoimmune disorders. The patient management was based on corticosteroid therapy and plasmapheresis to counter the persistent hemoptysis and hemoglobin serum level decline. The management strategy was based on the clinical suspicion of vasculitis and a torpid clinical evolution. Pulmonary sepsis ensued, resulting in patient's death. The necropsy report describes the primary cause of death as diffuse alveolar hemorrhage secondary to diffuse alveolar injury. This case report presents the detailed clinical, imagining and histopathological findings of a patient with alveolar hemorrhage secondary to cocaine consumption, as well as a review of the literature. (C) 2018 The Authors. Published by Elsevier Inc.