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Case report
Haemoptysis following shallow breath-hold diving in a cannabis user
  1. Janice Borg1,
  2. Julian Cassar2,
  3. Sarah Bonello2 and
  4. Peter Fsadni2
  1. 1Medicine, Mater Dei Hospital, Msida, Malta
  2. 2Respiratory, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Janice Borg; janice.c.borg{at}gov.mt

Abstract

We report the first case of a healthy 24-year-old male with a 6-year history of regular cannabis use, who presented with haemoptysis after a shallow 3 m breath-hold dive. Blood investigations showed mild neutrophilia. CT thorax revealed focal ground-glass changes in the superior segment of the lower lobe. With a suspicion of pneumonia, oral antibiotics were initiated to poor effect. Through bronchoscopic visualisation and lavage, a diagnosis of diffuse alveolar haemorrhage was established. The clinical course was benign with resolution of symptoms and changes on CT thorax within 6 weeks of stopping marijuana use. Since all other causes of haemoptysis were excluded, pathophysiology was attributed to cannabis-induced lung parenchymal damage, exacerbated by a shallow breath-hold dive. To ensure appropriate management, a clinician should therefore have a high index of suspicion for drug use and other factors known to cause chronic lung damage in whom other causes of diffuse alveolar haemorrhage are excluded.

  • respiratory medicine
  • drugs misuse (including addiction)
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Footnotes

  • Contributors All authors contributed to the care of the patient and the planning and reporting of the work. JB wrote the case report and carried out the preparation and the write up for the discussion. JC and SB appraised the case report and was also involved in the literature review. PF was the patient’s caring consultant who also reviewed the case report prior to publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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