MANAGEMENT OF METHAMPHETAMINE INDUCED PNEUMONITIS

ABSTRACT

CASE A 35-year-old female with history of pulmonary coccidiomycosis s/p treatment 15 years ago, ex-smoker who quit 8 years ago, unvaccinated for COVID-19 presented with two weeks of progressively worsening shortness of breath, fever, chills, generalized body aches, sore throat with hoarseness of voice, nonproductive cough, wheezing and midsternal chest pain. Denied sick contacts, recent travel, allergies or bird contact. On presentation, vitals were significant for hypoxia with SpO2 84% requiring 2L of nasal canula, sinus tachycardia to 109, tachypneic in 30s. Physical exam showed stridor and bilateral diffuse expiratory wheezing. Stridor improved with racemic epinephrine and dexamethasone 10mg IV. CBC, CMP, Procalcitonin, BNP, COVID-19 and Respiratory PCR were negative, while coccidioidomycosis antibody was positive. UDS was positive for methamphetamine. Chest X-ray showed features of atypical pneumonitis. CT Chest showed similar findings and was negative for pulmonary embolism. She was managed symptomatically with albuterol inhaler. Respiratory symptoms improved during hospitalization without any further interventions. IMPACT/DISCUSSION: Methamphetamine can cause toxic lung parenchyma injury irrespective of frequency of use. With recent increase in use of methamphetamine, paucity of literature and unclear mechanism in lung injury, it is important for physicians to be aware of methamphetamine associated lung injury as a differential diagnosis of acute/subacute respiratory distress with the risk factors of illicit drug use in the era of COVID pandemic. According to National Survey on Drug Use and Health (NSDUH) in 2018, 1.6 million people (age > 26 years) used methamphetamine in one year which is 0.5% more than 2016-2017. Crystalline methamphetamine is a widely used inhaled stimulant with few reported cases of acute respiratory distress syndrome, eosinophilic pneumonia, pneumonitis, and diffuse alveolar hemorrhage. Even though the mechanism of injury is unclear in human beings, toxicity was studied in animals. Chronic methamphetamine use causes thickened alveolar walls and reduced alveolar sacs by oxidative stress and by increased free radical formation. Patients often present with non-specific symptoms including cough, shortness of breath, sore throat or chest pain. The temporal relation of symptomatology with methamphetamine use and exclusion of infectious and other pulmonary etiology based on labs and radiological findings are crucial in establishing the diagnosis. Early diagnosis, symptomatic treatment and cessation of substance use are core management. CONCLUSION: We discussed a case of methamphetamine-induced pneumonitis, who presented with upper and lower respiratory symptoms that resolved dramatically with the early diagnosis and supportive care. We recommend considering methamphetamine-induced lung injury as a differential diagnosis in patients with risk factors of illicit drug use, especially in the era of the COVID-19 pandemic for early diagnosis and appropriate management.