Inhalant Abuse and Hemoptysis: Is there really cause and effect?

March 9, 2010, 8:19 pm

★★☆☆☆

Inhalant Abuse: A Case of Hemoptysis Associated with Halogenated Hydrocarbon Abuse.  Schloneger M et al.  Pediatr Emerg Care 2009;25:754-757.

Abstract

This case report describes an 18-year-old male with respiratory difficulty — initially treated as pneumonia — that eventually was diagnosed as massive pulmonary hemorrhage.  Many rare causes of this condition — Goodpasture syndrome, bacterial and viral pneumonia, Wegener granulomatosis, etc — were ruled-out.  Despite intensive treatment, the patient’s respiratory condition continued to deteriorate and he died on the 11th hospital day.

Because the patient’s mother revealed that he had been huffing keyboard cleaner (tetrafluoroethane), the authors report this association but are careful to say that any cause-and-effect relationship is speculative, and has not been previously reported.

All well and good, but there is one massive flaw in this report.  Smoking cocaine and/or crack is a known cause of hemoptysis.  This was not ruled out in the case report, and it is interesting that no urine drug screen was sent. (Apparently the patient denied cocaine use, but then again he appears to have denied hydrocarbon inhalation.)  However, there is one important take-home lesson from this paper: when a patient develops anemia and worsening respiratory status, pulmonary hemorrhage should be suspected.

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