Rates of cocaine use in the UK remain high and Physicians need to be familiar with pleuropulmonary complications associated with illicit use. Respiratory symptoms (e.g cough productive of carbonaceous material/chest pain/dyspnoea/haemoptysis/wheeze) are quite common after cocaine exposure and can lead to barotrauma/asthma/ischaemic-airways-necrosis/pneumonia/interstitial-lung-disease/pulmonary-hypertension, not only after smoking volatilized crack cocaine and the combustion products/associated substances (tobacco/heroin/talc).

Proposed mechanisms that cause this, relate to the effect of cocaine on alveolar macrophages, intermixed substances and bacterial contamination.

A normally well, HIV-negative female who habitually snorts cocaine, presents with 40C°fever, chest pain and sweats. Although a smoker, she denies IVDU/smoking crack-cocaine. CXR shows a 5.5 cm thick walled left upper lobe lung abscess, associated with surrounding ground-glass consolidation, broadly based on the anterior pleura, but originating in the lung, infiltrating the anterior chest wall with reactive intercostal muscle changes on CT. She had no evidence of, nor risk factors for bacteraemia such as skin disorder, prosthetic devices, or immunosuppression. was isolated only on transcutaneous aspiration of abscess. Good therapeutic clinical/biochemical/radiological response to 6 weeks of antibiotics via OPAT.

Nasal insufflation of cocaine may cause lung complications such as lung abscess via primary infection of the lung rather than haematogenous spread. This may be due to contamination of cocaine when mixing it with other substances or the effects of cocaine on alveolar macrophages.

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