Acute respiratory distress and hemoptysis: a case report of drug-induced lung injury aka "crack lung".

Background: With the increasing use of inhaled drugs such as cocaine and amphetamines, drug-induced lung injury has become a relevant condition in emergency settings. "Crack lung" is a well-documented, acute pulmonary syndrome associated with inhalation of cocaine, characterized by respiratory distress, hemoptysis, and various radiographic findings. While the syndrome is more common among younger individuals, it can present in older patients, often triggered by the acute use of inhalative drugs.

Case description: A 60-year-old obese male with no significant history of lung or cardiac disease presented to the emergency department with sudden-onset dyspnea, severe hemoptysis, palpitations, and tachycardia. Vital signs indicated hypertension (180/110 mmHg) and hypoxia [peripheral capillary oxygen saturation (SpO₂) of 80% on room air]. The electrocardiogram (ECG) revealed sinus tachycardia but no right bundle branch block (RBBB). Laboratory tests were mostly unremarkable, and a computed tomography (CT) scan ruled out pulmonary embolism but showed diffuse bronchial wall thickening consistent with bronchitis or atypical pneumonia. During the clinical interview, the patient admitted to recent use of inhaled cocaine and amphetamines, leading to the diagnosis of early-stage "crack lung". After stabilization by administration of oxygen, bronchodilatators and prednisolone, the patient was discharged with follow-up care focusing on cessation of drug use and monitoring for potential lung damage. Bronchoscopically, there was no evidence of another cause of hemorrhage such as tumor growth.

Conclusions: This case highlights the importance of recognizing drug-induced lung injury in patients presenting with acute respiratory distress and hemoptysis. As the use of inhaled drugs such as cocaine continues to rise in Germany, awareness of conditions like "crack lung" is essential for timely diagnosis and management. Steroids may play a role in reducing inflammation, but further research is needed to establish standardized treatment protocols for this condition.