Cannabis induced hemoptysis: A rare complication of a commonly used illicit substance.
INTRODUCTION: Cannabis is the most commonly used illicit drug in the United States. Cannabis has known to cause respiratory problems and several reports have linked cannabis use to pneumothorax, pneumomediastinum and bullous lung diseases. To date only two cases have been reported of cannabis induced hemoptysis and only one in English literature. Here we present series of two cases of cannabis induced hemoptysis. CASE PRESENTATION: #1: 26-year-old female, daily cannabis smoker, presented for evaluation of sudden onset dyspnea and scant hemoptysis. Toxicology on presentation was positive only for cannabinoids. CT findings were consistent with airspace disease in the left lung. CT scan of chest demonstrated bilateral airspace disease. Cardiology workup, extensive autoimmune and infectious workup were negative. Symptoms resolved spontaneously after stopping cannabis and diagnosis of cannabis induced hemoptysis was made by excluding other diagnosis. #2:21-year-old male, daily cannabis smoker, presented with two months history of cough and four weeks history of hemoptysis with hemodynamic stability. A CT of the chest with contrast demonstrated multifocal opacities in the right upper and lower lung. He was treated for pneumonia but symptoms persisted. He underwent evaluation for cardiogenic, ENT, immunologic and infectious etiology on return, which were unrevealing. During the second day of his hospitalization, there was complete resolution of symptoms. DISCUSSION: Hemoptysis is defined as the expectoration of blood from the bronchial tree, parenchyma or the alveoli. Though rare, it has been reported in conjunction with cannabis use. Both of our patients were daily users of cannabis. Stopping the cannabis resulted in complete resolution of hemoptysis in both patients. The paucity of data on this presentation makes it impossible to determine who is at risk or the long-term implications of this. It is highly likely that the presence of contaminants in cannabis substantiate this risk. Both patients had diffuse alveolar opacities on CT scan. Radiographic findings seem to suggest injury at alveolar level however as the association between hemoptysis and cannabis use has only been reported in two other case reports, the pathophysiology, presentation and progression of this is not as well understood. CONCLUSIONS: Though reports of cannabis induced hemoptysis have demonstrated chronic inflammation on biopsy in otherwise healthy parenchyma, little is known about the progression of injury in the respiratory tract following cannabis exposure. Cannabis associated hemoptysis is a rare complication of cannabis use but is seen in association with small airspace opacities on imaging. Discontinuation of cannabis resulted in immediate resolution of symptoms in all reported cases. These cases highlight the deficits in information regarding the effect of cannabis use on pulmonary health.
Shams C, Dalal B. Cannabis-induced hemoptysis: a rare complication of a commonly used illicit substance. Chest. 2018 Oct 1;154(4):800A.