Marijuana, considered the most prevalent illegal drug in the world, is used both recreationally for its psychoactive effects, and in the medical sphere for its therapeutic purposes (analgesia, muscle relaxation, appetite stimulation). The most common route of administration is by inhalation which brings with it potentially harmful consequences to pulmonary function. A recent case published in the journal Medicine discusses a rare and potentially fatal side effect of cannabis smoking, hemoptysis.

This case reports on a 38-year-old male who presented to the hospital with shortness of breath and cough with hemoptysis following marijuana smoking. Further investigation indicated the following:

  • Patient was afebrile
  • BP: 122/81mmHg
  • Heart rate: 79 beats/min
  • Oxygen saturation: 90% in room air
  • Lung exam: bibasilar rales
  • Chest radiograph, CT scans: bilateral diffuse ground-glass opacities
  • Bronchoscopy with bronchoalveolar lavage (BAL): initially bloody, then became clear
  • BAL cell counts: leukocytes 120 cells/mm3, with 98% neutrophils; RBCs 28,250 x 106 cells/mm3
  • Transbronchial biopsy: chronic inflammation
  • Hemoglobin: 15.8g/dL
  • Coagulation profile: normal
  • Antinuclear antibody, rheumatoid factor, anti-DNA antibody, antiglomerular basement membrane antibody: negative
  • Beta natriuretic peptide: 13pg/mL
  • Urine toxicology: positive for cannabinoids

Because cultures came back negative, antibiotics were discontinued and the patient received a dose of furosemide. His shortness of breath and hemoptysis subsequently resolved and a chest radiograph before discharge indicated complete resolution of infiltrates. At discharge, he was told to follow-up at the pulmonary clinic.