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Synthetic Cannabinoids as a Cause for Black Carbonaceous Bronchoalveolar Lavage
October 2013, Vol 144, No. 4_MeetingAbstracts Allergy and Airway | October 2013
Synthetic Cannabinoids as a Cause for Black Carbonaceous Bronchoalveolar Lavage Kerron Catlyn, MD; Natalia Moguillansky, MD; Hiren Mehta, MD; Michael Jantz, MD; Vipul Patel, MD University of Florida, Gainesville, FL Chest. 2013;144(4_MeetingAbstracts):23A. doi:10.1378/chest.1703301
Abstract SESSION TITLE: Bronchology Case Report Posters II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM INTRODUCTION: Synthetic cannabis is a psychoactive designer drug derived from natural herbs and sprayed with synthetic chemicals that can mimic the effects of cannabis. It is best known by the brand names K2 and Spice. Even though synthetic cannabis appeared in the early 2000s, research on its safety is becoming available now and only concentrates on the psychiatric disorders[1]. Only one case report on pulmonary complications of smoking this drug has been published in the past[2]. CASE PRESENTATION: A 44 year-old woman presented to the hospital with a five day history of fever, productive cough and dyspnea. She had past medical history of HIV diagnosed three years prior. She was off highly active antiretroviral therapy. Her CD4 count was 3.4 UL and viral load was 250,000 copies/ml on presentation. She also reported having multiple treatments for pneumocyctis jiroveci pneumonia. She was being treated for non tuberculous mycobacteria on clarithromycin, ethambutol and rifabutin. Social history revealed remote history of smoking in her 20’s, however for the past four years she has been smoking Spice, a synthetic cannabinoid. She denied cocaine or other drug usage. On admission her complete blood cell count, urine analysis and serum electrolytes were normal. Blood culture and sputum culture showed no growth. Chest x ray showed airway opacities on the right middle lobe suggestive of pneumonia. CT scan of the chest revealed patchy airspace disease in upper lobes bilaterally. Extensive work up was performed including negative serology for toxoplasma, histoplasma, legionella, and Cryptococcus and blastomycosi. She was started on broad spectrum antibiotics for possible bacterial infection, atovaquone for PJP and clarithromycin, ethambutol and levofloxacin for mycobacterial infection. Bronchoscopy revealed normal airway however on BAL, black colored, carbnaceous fluid was returned. Transbronchial biopsies were also black.
DISCUSSION: The findings of carbonaceous material in the BAL of cocaine users and occupational exposures such as silica, metal and alloids have been described in the past. Pulmonary complications may result from impurities inhaled during the process of cocaine smoking or occupational exposures. We propose that these synthetic cannabinoids can do the same by a similar mechanism. CONCLUSIONS: Black carbonaceous fluid is a BAL finding in users of synthetic cannabis. Reference #1: Hermanns-Clausen, M., et al., Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction, 2013. 108(3): p. 534-44. Reference #2: Loschner, A., Diffuse Alveolar Hemorrhage: Add “Greenhouse Effect” to the Growing List. Chest, 2011. 140(4). Reference #3: Klinger, J.R., E. Bensadoun, and W.M. Corrao, Pulmonary complications from alveolar accumulation of carbonaceous material in a cocaine smoker. Chest, 1992. 101(4): p. 1171-3. DISCLOSURE: The following authors have nothing to disclose: Kerron Catlyn, Natalia Moguillansky, Hiren Mehta, Michael Jantz, Vipul Patel No Product/Research Disclosure Information
Synthetic Cannabinoids as a Cause for Black Carbonaceous Bronchoalveolar Lavage Kerron Catlyn, MD; Natalia Moguillansky, MD; Hiren Mehta, MD; Michael Jantz, MD; Vipul Patel, MD University of Florida, Gainesville, FL Chest. 2013;144(4_MeetingAbstracts):23A. doi:10.1378/chest.1703301
Abstract SESSION TITLE: Bronchology Case Report Posters II SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM INTRODUCTION: Synthetic cannabis is a psychoactive designer drug derived from natural herbs and sprayed with synthetic chemicals that can mimic the effects of cannabis. It is best known by the brand names K2 and Spice. Even though synthetic cannabis appeared in the early 2000s, research on its safety is becoming available now and only concentrates on the psychiatric disorders[1]. Only one case report on pulmonary complications of smoking this drug has been published in the past[2]. CASE PRESENTATION: A 44 year-old woman presented to the hospital with a five day history of fever, productive cough and dyspnea. She had past medical history of HIV diagnosed three years prior. She was off highly active antiretroviral therapy. Her CD4 count was 3.4 UL and viral load was 250,000 copies/ml on presentation. She also reported having multiple treatments for pneumocyctis jiroveci pneumonia. She was being treated for non tuberculous mycobacteria on clarithromycin, ethambutol and rifabutin. Social history revealed remote history of smoking in her 20’s, however for the past four years she has been smoking Spice, a synthetic cannabinoid. She denied cocaine or other drug usage. On admission her complete blood cell count, urine analysis and serum electrolytes were normal. Blood culture and sputum culture showed no growth. Chest x ray showed airway opacities on the right middle lobe suggestive of pneumonia. CT scan of the chest revealed patchy airspace disease in upper lobes bilaterally. Extensive work up was performed including negative serology for toxoplasma, histoplasma, legionella, and Cryptococcus and blastomycosi. She was started on broad spectrum antibiotics for possible bacterial infection, atovaquone for PJP and clarithromycin, ethambutol and levofloxacin for mycobacterial infection. Bronchoscopy revealed normal airway however on BAL, black colored, carbnaceous fluid was returned. Transbronchial biopsies were also black.
DISCUSSION: The findings of carbonaceous material in the BAL of cocaine users and occupational exposures such as silica, metal and alloids have been described in the past. Pulmonary complications may result from impurities inhaled during the process of cocaine smoking or occupational exposures. We propose that these synthetic cannabinoids can do the same by a similar mechanism. CONCLUSIONS: Black carbonaceous fluid is a BAL finding in users of synthetic cannabis. Reference #1: Hermanns-Clausen, M., et al., Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction, 2013. 108(3): p. 534-44. Reference #2: Loschner, A., Diffuse Alveolar Hemorrhage: Add “Greenhouse Effect” to the Growing List. Chest, 2011. 140(4). Reference #3: Klinger, J.R., E. Bensadoun, and W.M. Corrao, Pulmonary complications from alveolar accumulation of carbonaceous material in a cocaine smoker. Chest, 1992. 101(4): p. 1171-3. DISCLOSURE: The following authors have nothing to disclose: Kerron Catlyn, Natalia Moguillansky, Hiren Mehta, Michael Jantz, Vipul Patel No Product/Research Disclosure Information