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1914: SYNTHETIC CATHINONE INHALATION RESULTING IN DIFFUSE ALVEOLAR HEMORRHAGE

Learning Objectives: Synthetic cathinones (SCs) have gained popularity as recreational drugs since 2012 in Japan, and SC poisoning sometimes results in organ dysfunction. However cases of diffuse alveolar hemorrhage (DAH) following inhalation of SCs have not previously been reported. We here present a case of DAH following SC intoxication. Methods: A 28-year-old man with a history of depression was found lying unconscious and brought to our ED. Upon arrival, he had a GCS of 4, and his vital signs were BP 117/37 mmHg, HR 118, RR 14, and SpO2 73% on a non-rebreather mask. He was intubated and underwent a lung CT scan, which revealed diffuse and bilateral ground glass opacities. BAL showed hemorrhagic effluent, and DAH was confirmed. Autoimmune and infective workups were unremarkable. He was admitted to the ICU and ventilated for 4 days. Although the cause of DAH was not identified, hypoxemia was ameliorated without adjunctive therapy such as corticosteroids. He was discharged on hospital day 7. About 2 months after discharge, he was brought to our ED again with unconsciousness. His chest x-ray showed recurrence of bilateral pulmonary infiltrates that was less serious than before, and he was admitted to the emergency ward. On hospital day 2, his consciousness normalized, and he confessed that he had inhaled a recreational drug before his hospitalization. He was discharged without clinical sequelae on hospital day 2. Later, it was reported by the health welfare department of the prefecture that the drug contained alpha-ethylaminopentiophenone and 4-fluoro-alpha-PVP, known as SCs. Results: Although there are some case reports that poisoning with illicit drugs (e.g., amphetamine and cocaine) resulted in DAH, we believe that this is the first report of DAH following SC inhalation. Because SCs are phenylalkylamine derivatives producing an amphetamine-like effect, it is reasonable that SC poisoning can cause DAH. For patients with sympathomimetic symptoms suffering from DAH, the possibility of illicit drug intoxication like SCs should be considered.