Management of Methamphetamine Induced Pneumonitis

Introduction: Methamphetamine can cause toxic lung parenchymal injury irrespective of frequency of use. It is important for physicians to be aware of methamphetamine associated lung injury as a differential diagnosis of acute respiratory distress in the era of COVID pandemic. Here we discussed a case of methamphetamine induced pneumonitis and its management. Case description: A 35-year-old female with history of pulmonary coccidiomycosis s/p treatment 15 years ago, ex-smoker (quit 8 years ago), unvaccinated for COVID-19 presented with two weeks of progressively worsening shortness of breath, fever, chills, generalized body aches, sore throat with hoarseness of voice, nonproductive cough, wheezing and midsternal chest pain. On presentation, vitals were significant for hypoxia with SpO2 84% requiring 2L of nasal canula, sinus tachycardia to 109, tachypneic in 30s. Physical exam showed stridor and bilateral diffuse expiratory wheezing. Stridor improved with racemic epinephrine and dexamethasone 10mg IV. CBC, CMP, Procalcitonin, BNP, COVID-19 and Respiratory PCR were negative, while coccidioidomycosis antibody was positive. UDS was positive for methamphetamine. Chest X-ray showed features of atypical pneumonitis. CT Chest showed similar findings and was negative for pulmonary embolism. She was managed symptomatically with albuterol inhaler. Respiratory symptoms improved during hospitalization without any further interventions. Discussion: According to National Survey on Drug Use and Health in 2018, 1.6million people (age >26years) used methamphetamine in one year which is 0.5% more than 2016-2017. Crystalline methamphetamine is a widely used inhaled stimulant with few reported cases of acute respiratory distress syndrome, eosinophilic pneumonia, pneumonitis, and diffuse alveolar hemorrhage. Even though mechanism of injury is unclear in human beings, toxicity was studied in animals. Chronic methamphetamine use causes thickened alveolar walls and reduced alveolar sacs by oxidative stress and by increased free radial formation. Patients often present with non-specific symptoms including cough, short of breath, sore throat or chest pain. The temporal relation of symptomatology with methamphetamine use and exclusion of infectious and other pulmonary etiology based on labs and radiological findings is crucial in establishing the diagnosis. Early diagnosis, symptomatic treatment and cessation of substance use are core management. Conclusion: We discussed a case of methamphetamine induced pneumonitis, who presented with upper and lower respiratory symptoms that resolved dramatically with the early diagnosis and supportive care. We recommend to consider methamphetamine induced lung injury as a differential diagnosis in patients with risk factor of illicit drug use, especially in the era of COVID-19 pandemic for early diagnosis and appropriate management. (Figure Presented).