SESSION TITLE: Miscellaneous Cases V
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 07:30 AM - 09:00 AM
INTRODUCTION: In 1995, Dr. John Huffman used synthetic compounds for research on neurogenic cannabinoid effects. After publication, these spread into public use, with nationwide exponential increase over the past 3 years, posing extreme cardiopulmonary risks toward users with little known on these substances. We present a healthy male who developed respiratory compromise with eosinophilic pleural effusion secondary to synthetic marijuana.
CASE PRESENTATION: A 45 y/o male presented with worsening dyspnea and pleuritic chest pain. He denied fever, night sweats, weight loss, hemoptysis, cough, wheezing, orthopnea, paroxysmal nocturnal dyspnea, rash, arthralgias, tuberculosis or asbestos exposure, trauma, or recent travel. He had a past history of smoking and cocaine abuse. He admitted to smoking K2: a synthetic marijuana. Physical exam revealed restricted inspiration secondary to pain and absent right basal breath sounds, but was otherwise unremarkable. Ancillary testing showed eosinophilia (7.2%) and an elevated D-dimer. CBC, BMP, LFT's, BNP, PT/PTT/INR, P-anca, C-anca, rheumatoid factor, ANA and stool for ova/parasites were unremarkable. CXR and CTA revealed a large right-sided pleural effusion, mediastinal lymphadenopathy, two small pulmonary nodules and no emboli. Thoracentesis revealed 550cc of orange turbid fluid, consistent with an exudative effusion, 45% eosinophils, 5,055 nucleated cells, and 10,284 RBC's. Tuberculosis, fungal, and bacterial cultures, and cytology were unremarkable. Pathology showed reactive mesothelial cells and numerous eosinophils. The diagnosis of eosinophilic pleural effusion secondary to synthetic marijuana was made.
DISCUSSION: With limited public awareness about cardiopulmonary complications of synthetic marijuana, it’s imperative that physicians educate patients and colleagues of the potential dangers of the drug. The past 3 years have demonstrated an exponential boom in cannabinoid use, exemplified by 6,955 calls received regarding harmful exposure last year, compared to just 15 in 2009. With the legalization of marijuana in 17 states, an omen of false portrayal exists that both synthetic and its organic counterpart are harmless. Synthetic marijuana however can be up to 100 times stronger and has been described to lead to life-threatening complications such as respiratory failure requiring ecmo, myocardial infarction, status epilepticus, hypertensive crises, suicide, and in our case, respiratory compromise secondary to eosinophilic pleural effusion. Dr. Huffman, himself, stated: "These things are dangerous—anybody who uses them is playing Russian roulette. We never intended them for human consumption."
CONCLUSIONS: Synthetic Marijuana is a more lethal compund that its organic counterpart. As a result patients can develop more severe complications such as cardiac and respiratory failure.
Reference #1: Jinwala.J Child Adolesc Psychopharmacol. 2012 Dec;22
Reference #2: Dunham SJ. Forensic Sci Int. 2012 Nov 30
DISCLOSURE: The following authors have nothing to disclose: Amitpal Nat, Shradda Goyal, Amritpal Nat, Arman Khorasani-zadeh, Amit Sharma, Michael Iannuzzi
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