Importance of Differential Diagnosis in Patients with Community-Acquired Pneumonia Using K-9 Drugs (spice)
DOI:
https://doi.org/10.17058/reci.v15i2.20061Keywords:
Pneumonia; Pneumonitis; Illicit drugs; Chemical dependentsAbstract
Community-acquired pneumonia (CAP) is a condition with high morbidity and mortality, particularly among users of inhaled drugs. The use of the synthetic drug K9 (spice) has been associated with chemical pneumonitis, whose clinical presentation can mimic respiratory infections, complicating diagnosis and appropriate management. This study reports the case of a 33-year-old male patient with a history of substance dependence and recent K9 use, who was hospitalized with severe respiratory failure. Laboratory tests, chest computed tomography, and microbiological and molecular analyses for infectious agents were performed. Initial treatment included empirical antibiotic therapy, invasive ventilatory support, and systemic corticosteroids. The absence of identifiable pathogens and compatible radiological findings led to the diagnosis of K9-induced chemical pneumonitis. Corticosteroid therapy resulted in progressive clinical improvement, allowing extubation and hospital discharge after 24 days, with referral for rehabilitation. This case highlights the importance of considering synthetic drugs in the differential diagnosis of CAP in young individuals with a history of substance use, preventing unnecessary antibiotic use and ensuring more targeted treatment. Additionally, it underscores the need for professional training to recognize clinical and radiological patterns suggestive of chemical pneumonitis, as well as the development of public policies aimed at preventing synthetic drug use and mitigating its impact on public health.
Downloads
References
United Nations Office on Drugs and Crime (UNODC). World Drug Report 2023. Vienna: UNODC; 2023. Disponível em: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
Smith RJ, Thompson M, Garcia J. Effects of inhaled substances on pulmonary immunity: a review. Respir Med. 2021;175:106190. https://doi.org/10.1016/j.rmed.2020.106190
Ministério da Saúde. Sistema de Informação Hospitalar do SUS (SIH/SUS). Datasus; 2023. Disponível em: http://datasus.saude.gov.br
Oliveira AM, Santos MC, Pereira AC. Fatores de risco associados à pneumonia adquirida na comunidade no Brasil. J Bras Pneumol. 2022;48(1):e20210137. https://doi.org/10.36416/1806-3756/e20210137
Torres A, et al. Chemical pneumonitis: clinical characteristics and management. Eur Respir J. 2020;56(5):2000070. https://doi.org/10.1183/13993003.00070-2020
Zhang X, Li Y. Impact of inhaled drugs on lung function and immune response. Front Pharmacol. 2021;12:703914. https://doi.org/10.3389/fphar.2021.703914
Gonzalez JF, Perez D, Martinez R. Pulmonary toxicity related to illicit drugs: mechanisms and clinical presentations. Pulm Pharmacol Ther. 2022;74:102081. https://doi.org/10.1016/j.pupt.2021.102081
Jones L, et al. Synthetic cannabinoids: a review of pharmacology, toxicology, and public health impact. Drug Alcohol Depend. 2020;215:108199. https://doi.org/10.1016/j.drugalcdep.2020.108199
Williams K, et al. Respiratory complications from synthetic cannabinoid use: a clinical overview. Chest. 2021;159(3):1093-1101. https://doi.org/10.1016/j.chest.2020.09.007
Jain S, et al. Community-acquired pneumonia during COVID-19 pandemic: clinical challenges. J Infect Dis. 2021;223(10):1626-1634. https://doi.org/10.1093/infdis/jiaa742
Kim S, et al. Hospital outcomes of community-acquired pneumonia: influence of drug use and comorbidities. Clin Infect Dis. 2022;74(1):132-140. https://doi.org/10.1093/cid/ciab849
Lee N, et al. Differentiating COVID-19 pneumonia from other causes: clinical and radiological clues. Respir Med. 2021;182:106399. https://doi.org/10.1016/j.rmed.2021.106399
Polverino E, Torres A. Community-acquired pneumonia and novel drugs. Future Microbiol. 2015;10(11):1797-817. https://doi.org/10.2217/fmb.15.91
Torres A, et al. Advances in bacterial pneumonia diagnosis and treatment. Lancet Infect Dis. 2019;19(5):e155-e164. https://doi.org/10.1016/S1473-3099(18)30517-4
Wood DM, Dargan PI. Novel psychoactive substances: understanding acute toxicity. Ther Drug Monit. 2012;34(4):363-7. (Mantida pela relevância)
Seely KA, et al. Synthetic cannabinoids and severe pulmonary toxicity: clinical insights. Pulm Pharmacol Ther. 2023;77:102158. https://doi.org/10.1016/j.pupt.2022.102158
GBD 2016 Alcohol and Drug Use Collaborators. Global burden of disease attributable to substance use: a systematic analysis. Lancet Psychiatry. 2018;5(12):987-1012. https://doi.org/10.1016/S2215-0366(18)30337-7
Monteiro MG, et al. Drug policy and health system challenges: impact on respiratory disease burden. Rev Saude Publica. 2020;54:61. https://doi.org/10.11606/s1518-8787.2020054002340
Published
Issue
Section
License
Copyright (c) 2025 André, Álvaro, Larissa, Luis Gustavo, Luiz Paulo, Victor, Dra. Silvia
This work is licensed under a Creative Commons Attribution 4.0 International License.
The author must state that the paper is original (has not been published previously), not infringing any copyright or other ownership right involving third parties. Once the paper is submitted, the Journal reserves the right to make normative changes, such as spelling and grammar, in order to maintain the language standard, but respecting the author’s style. The published papers become ownership of RECI, considering that all the opinions expressed by the authors are their responsibility. Because we are an open access journal, we allow free use of articles in educational and scientific applications provided the source is cited under the Creative Commons CC-BY license.
