01 - CRACK-LUNG; AN UNUSUAL CAUSE OF PAEDIATRIC RESPIRATORY FAILURE.

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Abstract

We present a case-report of a 15-year-old girl who developed severe respiratory failure following illicit drug use in the context of an unusual social background.
The patient presented to hospital with a 2 day history of haemoptysis and fever. She was continued to deteriorate following admission and required mechanical ventilation with a presumed diagnosis of pneumonia. Her ventilated course was unusual and pneumonia could not be confirmed. This initiated re-exploration of her history with the discovery of a significant social background.
The child’s parents had befriended a homeless man whom, it was later discovered, used illicit substances, was a sex-offender and had been recently released from prison. As a result the patient became involved with drug misuse. The exact number of substances used was not known but included cannabis, cocaine and heroin. Multiple subsequent investigations were negative but a lung biopsy showed likely pneumonitis, likely secondary to inhalation injury or ‘Crack-Lung’, due to its bronchio-central distribution. Her course was severe and prolonged; she was ventilated for 34 days, failed on ‘High-Frequency Oscillated Ventilation’ and was considered for ‘Extracorporeal-Membrane-Oxygenation’.
Social history can be neglected during an acute presentation especially when ‘the story fits’. In this case, the subsequent story did not fit and further exploration was warranted. Fortunately, ‘Crack-Lung’ is not frequently encountered by paediatricians. This case emphasises the importance of a meticulous social history with a degree of suspicion to aid the detection of unexpected diagnoses, usually found in the adult population.