Unilateral Diffuse Alveolar Hemorrhage in a Polysubstance User: A Case Report

TL;DR

A 32-year-old man with a history of heavy drug use developed severe lung bleeding, highlighting the risk of drug-induced alveolar hemorrhage.

Contribution

This case report highlights drug-induced diffuse alveolar hemorrhage as a rare but critical complication of polysubstance abuse.

Findings

The patient's condition was confirmed as diffuse alveolar hemorrhage via bronchoscopy.

Polysubstance use, especially cocaine and opioids, was linked to alveolar injury and hemorrhage.

Early recognition and intensive care led to a successful recovery.

Abstract

Diffuse alveolar hemorrhage (DAH) is a rare but severe condition characterized by bleeding into the alveolar spaces, which can lead to acute respiratory failure. The most common causes are vasculitides and autoimmune diseases, but the growing presence of illicit drugs such as cocaine and opioids in the lives of young adults has turned these into risk factors as well. We present a 32-year-old man with a history of heavy daily alcohol consumption (>350 g/day) and inhalational use of cannabis, cocaine, and heroin. He was found unconscious at home, with partial recovery of consciousness after administration of naloxone, leading to the assumption of an opioid overdose. He subsequently developed hypoventilation of the left hemithorax, severe global respiratory failure, and required invasive mechanical ventilation. Chest computed tomography revealed confluent consolidations involving almost the entire left lung, consistent with diffuse alveolar hemorrhage. The diagnosis was confirmed by bronchoscopy with hemorrhagic bronchoalveolar lavage. Treatment included ventilatory support, empiric antibiotics, and supportive therapy for withdrawal. After a favorable clinical course, he was discharged with follow-up at a specialized support center. Drug-induced DAH represents a diagnostic and therapeutic emergency. Polysubstance use, particularly the combination of cocaine and opioids, can cause alveolar injury and diffuse hemorrhage. Early recognition and intensive supportive care are essential for recovery. This case highlights the importance of considering DAH in patients with drug intoxication, especially in the context of simultaneous substance use. A high level of clinical suspicion is required for prompt diagnosis and appropriate intervention.

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