Illicit substances, such as cocaine, are associated with alveolar hemorrhage. Anti-Glomerular Basement Membrane (GBM) Disease and Goodpasture Syndrome with alveolar hemorrhage are rare immunologic diseases that are associated with a number of risk factors, and without treatment have significant mortality rates. Methamphetamine use is a growing public health concern, and its manufacture is common in regions of the United States. Methamphetamine has not previously been associated with alveolar hemorrhage. This study addresses the association with alveolar hemorrhage and methamphetamine.
A single institution retrospective case study from an urban university tertiary care hospital and referral center. A systematic review of pathology reports and database of cases with alveolar hemorrhage.
A total of two cases (n = 2), both 22 year-old females, were admitted with frank hemoptysis and acute respiratory failure. The medical history was significant for substance abuse, tobacco abuse and both were associated with the use and manufacturing of methamphetamine. Bronchoalvelar lavage demonstated alveolar hemorrhage in both, with increasingly bloody lavage fluid. Urinalysis was bland with normal creatinines. The open lung biopsy demonstrated, in both, primarily alveolar hemorrhage, with one associated with capillaritis with areas of organization. Immunofluorescence revealed prominant linear staining of the alveolar basement membranes for immunoglobulin IgG and complement C3, as did the glomerular basement membranes on the renal biopsies. Both were serum anti-GBM antibody negative. Plasmapheresis was performed in addition to the administration of parenteral corticosteroids, with resolution of the acute respiratory failure. There were no recurrences.
This study demonstrates the association of an Anti-GBM negative, Goodpasture-like Alveolar Hemorrhage Syndrome with Methamphetamine, its manufacture, or related to a component of manufacturing. Further studies are necessary to elucidate this new association.
This study raises a new serious public health concern with the increase appearance of the manufacturing and use of methamphetamine in the Midwest region of the United States. This is a new association based on a Medline Search from 1966 –2005 for alveolar hemorrhage, anti-GBM disease, Goodpasture syndrome, and methamphetamine.
Carl Kaplan, None.