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Acta Medica Colombiana

Print version ISSN 0120-2448

Acta Med Colomb vol.45 no.3 Bogotá July/Sept. 2020  Epub June 06, 2021 

Images in internal medicine

Cocaine-induced alveolar hemorrhage

Javier Enrique Fajardo-Riveroa 

Kristhel Andrea Neira-Trianab  * 

a Médico Neumólogo Universidad de La Sabana. Neumólogo Hospital Universitario de Santander. Docente Universidad Industrial de Santander; (Colombia)

b Médico Cirujano Universidad Industrial de Santander. Bucaramanga (Colombia). Médico General Fundación Oftalmológica de Santander (FOSCAL), Floridablanca (Colombia).

This was a 28-year-old woman with a history of well-controlled asthma, who had smoked 15 cigarettes per day since age 10, and used alcohol and basuco (unpurified cocaine base) since age 12. Four hours after using basuco she began to have dyspnea and a productive cough with bloody sputum, coupled with coarse rales and negative HIV. A chest tomography showed peripheral aveolar-interstitial opacities in the upper and middle lobes. The histopathology of a bronchoalveolar lavage showed numerous hemosiderophages related to pulmonary hemorrhage foci.

Figure 1. Axial high-resolution chest tomography image, lung window, with evidence of alveolar-interstitial opacities in the middle lobe. 

Figure 2. Axial high-resolution chest tomography image, lung window, showing alveolar-interstitial opacities in the anterior segments of the upper lobes. 

Figure 3 Cytology of the bronchoalveolar lavage showing numerous macrophages with brown intracytoplasmic pigment (hemosiderophages). 

Crack lung is an acute pulmonary syndrome which presents following the consumption of crack cocaine and is considered to be a rare and potentially fatal complication. The diagnosis is based on clinical assessment, imaging and a significant hemosiderophage count in relation with pulmonary hemorrhage 1,2. Treatment con sists of stopping the consumption of the toxic substance. The use of systemic corticosteroids is controversial 1,3,4. In our patient, inhaled corticosteroids were used with a satisfactory outcome.


1. Haim DY, Lippmann ML, Goldberg SK, Walkenstein MD. The pulmonary complications of crack cocaine. A comprehensive review.Chest .1995;107(1):233-40. [ Links ]

2. Terra Filho M, Yen CC, Santos Ude P, Muñoz DR. Pulmonary alterations in cocaine users.Sao Paulo Med J.2004;122(1):26-31. [ Links ]

3. Forrester JM, Steele AW, Waldron JA, Parsons PE. Crack lung: an acute pulmonary syndrome with a spectrum of clinical and histopathologic findings.Am Rev Respir Dis .1990;142(2):462-7. [ Links ]

4. Gatof D, Albert RK. Bilateral thumb burns leading to the diagnosis of crack lung.Chest .2002;121(1):28991. [ Links ]

Received: August 26, 2019; Accepted: April 13, 2020

* Correspondencia: Dra. Kristhel Andrea Neira-Triana. Bucaramanga (Colombia). E-mail:

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