Bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine addict

Evaluation of oxidative stress and its association with drug therapy in inpatients treated for cocaine dependence

The use of cocaine affects several systems and organs of the human body and the consumption of this substance leads to an increase in the production of reactive oxygen species, and to the reduction of antioxidant defenses. The aim of this study was to evaluate the oxidative stress (OS), biochemical and hematological parameters in patients hospitalized for treatment of cocaine addiction, comparing levels at hospital admission and discharge. Forty patients were included in the study. OS was evaluated using catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GPx), total antioxidant power (FRAP), malondialdehyde (MDA), and sulfhydryl group (GS). The medications used during hospitalization were registered and their influence on the parameters of OS was analyzed. After the hospitalization period, there was an increase in GGT levels, a reduction in SOD activity, and an increase in GPx activity and FRAP levels. Carbamazepine users had higher SOD values and lower FRAP values at hospital discharge. The use of chlorpromazine caused differences in creatinine and gamma-glutamyltransferase (GGT) serum leves, and the levels of glutamic oxalacetic transaminase (TGO), MDA, and FRAP were increased at hospital discharge. Haloperidol and thiamine during hospitalization interfered with alkaline phosphatase levels. The use of risperidone caused an increase in the levels of SOD, and folic acid use was associated with lower levels of GPx and higher levels of glutamic-pyruvic transaminase (TGP) and alkaline phosphatase. Drug rehabilitation treatment was effective in decreasing oxidative damage represented by the reduction of biological markers.

[Pulmonary complications in cocaine users]

Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.

Spontaneous pneumothorax in cocaine users

BACKGROUND

Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment.

AIM

We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax.

DESIGN

Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution.

RESULTS

Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120-239). All subjects are now well, with no evidence of pneumothorax.

CONCLUSIONS

Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.

[Pneumomediastinum and cocaine use]

INTRODUCTION

In France, cocaine is the second most commonly used illicit drug after cannabis. It can be responsible for many respiratory disorders among which pneumomediastinum.

OBJECTIVES

Systematic literature review of data on pneumediastinum in cocaine users. Documentary sources. Medline, on the period 1980-2016 with the keywords "pneumomediastinum" and "cocaine" or "free-base" or "freebasing" or "crack"; limits "title/abstract"; the selected languages were English or French. Among 72 articles, 48 abstracts have given use to a dual reading to select 37 studies.

RESULTS

Thirty-five selected articles related 44 subjects (sex-ratio: 5.2) whose age ranged from 15 to 36 years. Fourteen subjects used cocaine nasally and 30 others smoked it (12 as free-base and 18 in the form of crack). Thirty-two subjects had an isolated pneumomediastinum and 12 others had a pneumomediastinum combined with other gaseous effusions (pneumothorax, pneumopericardium, pneumoperitoneum or pneumorachis). Chest pain of sudden onset in the most common symptom which is often associated with tightness or swelling of the neck; more rarely there are dyspnea and/or a dry cough. The time between taking cocaine and the onset of the symptoms varies from a few minutes to 3 days. The course is usually good with healing in 1 to 4 days.

CONCLUSION

Cocaine use may be responsible for spontaneous pneumomediastinum. Practitioners must seek cocaine use in case of pneumomediastinum in a young person and consider the diagnosis in the case of sudden chest pain in cocaine users; they must help them to stop their consumption.