Upper airway obstruction and acute lung injury associated with cocaine abuse

We describe the case of a 14-year-old boy who developed airway obstruction due to acute upper respiratory tract infection. Following emergency tracheostomy, he developed pulmonary oedema and required ventilation. The postoperative course was complicated by the development of adult respiratory distress syndrome, characterised by marked respiratory distress, diffuse pulmonary infiltrates on chest radiography, reduced pulmonary compliance and marked increase in alveolar-arterial oxygen difference. He also developed persistent high-grade pyrexia, renal failure and cardiac instability. A social history of substance abuse (crack cocaine, amphetamines, alcohol and cigarettes) was obtained three weeks post-admission and is thought to have made a significant contribution to the severity of his disease.