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The number of drugs which adversely affect the respiratory system continues to increase and their effects pose a great challenge to all physicians. The range of reactions is wide, from familial simple pharmacological effects through less well understood reactions to the infective complications of immunosuppressants.
A 28-years old male with no significant medical history presented to ED with acute respiratory distress. He was intubated and placed on broad spectrum spectrum antibiotics. Initial blood gas investigation was suggestive of Type 2 Respiratory Failure. He was then diagnosed with ARDS (PaO2:FiO2<200 and bilateral lung infiltrates present on chest X-ray) related to substance abuse,which was confirmed through subsequent further history and a positive urine toxicology screen (positive for metamphetamine). The diagnosis was made after further exclusion of other etiological factors.Patient was admitted to ICU and empiric antibiotics,diuretics was continued there. Echocardiogram showed normal findings, CT Thorax reported as extensive consolidations and ground glass changes in both lungs. Patients ventilation was weaned down and subsequently extubated on the second day of ICU admission.Repeated chest X-ray after 48 hours of presentation showed lesser infiltrates on bilateral lung in comparison with the previous X-ray. Patient recovered within 6 days of ICU admission and was discharged then with subsequent follow up given.
Drug induced ARDS is a diagnosis of exclusion. There is the need to rule out other disease before making the diagnosis of drug induced ARDS. Drug Induced ARDS can be suspected if a patient is exposed to the drug develops new signs and symptoms and has a remittance of these symptoms once the drug is withheld. Similarly, the rapid improvement with no serious overall sequelae is unique and may be related to the underlying cause of ARDS in this patient.
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