B26-19 Recurrent Diffuse Alveolar Hemorrhage Associated With Smoking Cannabis
Abstract
Diffuse alveolar hemorrhage (DAH), a potentially life-threatening condition, is characterized by bleeding into the alveoli due to disruption of the alveolar-capillary basement membranes. The etiology is usually inflammation or injury from vasculitis, infection, or certain drugs. More recently, inhalation injury from crack cocaine, tobacco, or marijuana is increasingly being noted as a potential cause. We present a case of DAH associated with smoked marijuana.
A 34-year-old female with a history of seizures, migraines, and occasional cannabis use presented with an unwitnessed tonic clonic seizure and hemoptysis. She had non-compliance with levetiracetam for two days and reported recent smoked cannabis use. CT of the chest showed diffuse infiltrates, mainly on the left side. Four months prior, she had a similar presentation with similar CT findings. A bronchoscopy showed hyperemic mucosa with bloody secretions on the left and right upper lobes. Serial bronchoalveolar lavage of both lobes showed increasingly bloody secretions, which was confirmed by cell counts. Hence, the diagnosis of DAH was established. On both occasions, extensive autoimmune workup, including anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane (GBM), and anti-cyclic citrullinated peptide (CCP), was negative. Symptoms resolved rapidly after a 3-day course of high dose methylprednisolone. She briefly required high flow oxygen support, which was weaned off soon. Considering the…
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