Diffuse alveolar hemorrhage in cannabis smokers. A systematic literature review

• Published in: Revue des maladies respiratoires Vol. 40; no. 6; p. 506
• Main Authors: Underner, M, Perriot, J, Peiffer, G, Urban, T, Jaafari, N
• Format: Journal Article
• Language: English; French
• Published: France 01.06.2023
• Subjects: Anemia - complications; Cannabis; Hemoptysis - etiology; Hemorrhage - diagnosis; Humans; Lung Diseases - etiology; Pulmonary Alveoli; Smokers; Maladies pulmonaires; Tabagisme; Cannabis; Hémorragie alvéolaire; Alveolar hemorrhage; Lung diseases; Tobacco smoking; Marijuana
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2023.03.007

Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up.