Aggrevation of allergic bronchopulmonary aspergillosis by smoking marijuana

We report a case of allergic bronchopulmonary aspergillosis occurring in a female with severe asthma. Despite treatment with itraconazole and systemic corticosteroids, the patient's clinical course was characterized by multiple relapses. Intermittent periods of marijuana smoking were clearly associated with these relapses. Smoking marijuana was documented by questioning and by urinary measurement of tetrahydrocannabinol, the main active principle of cannabis. Samples of marijuana obtained from the patient yielded heavy growth of Aspergillus fumigatus and A. favus. We suggest that smoking marijuana should be systematically investigated as a potential environmental source of chronic exposure to Aspergillus in patients with allergic bronchopulmonary aspergillosis that is difficult to control. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.