[Pulmonary microscopic lesions in drug addicts--a preliminary report]

A sudden death of drug addicts is generally attributed to the depressive effect of substances in question on the respiratory center in the CNS. Microscopic morphology of lungs is relatively rarely dealt with.

This study probes into the morphology of individuals who were intoxicated by amphetamine and/or heroin and suddenly died.

The investigated group comprised lung specimens collected in the files of the Department of Forensic Medicine of Medical University of Warsaw in the years 2002-2004. A total of 41 autopsied drug addicts suddenly succumbed without any medical intervention. Formol-fixed paraffin blocks were stained with HE. The presence of opiates and/or amphetamine was investigated in body fluids at autopsy and recorded. The control group of 50 non-addicts originated from the files of the Department of Pathomorphology of the Rheumatologic Institute of Warsaw. Immunohistochemistry for alpha-1-antitripsin was performed in both groups.

The microscopic image of the lungs in the investigated group showed a pronounced hyperemia of the thickened interalveolar septa. The alveoli and alveolar ductules were enormously expanded by fluid, which contained numerous air bubbles of variable, rather striking sizes. The fluid showed multiple hemosiderin-loaded macrophages. The reaction for alpha-1-antitripsin was negative. Microscopy of the lungs from the control group failed to demonstrate any essential abnormalities. The reaction for alpha-1-antitripsin was positive.

Microscopy of the lungs of drug addicts is characteristic and attributed to drug. The pathologist facing such a picture is obliged to review and discuss with the clinician the possibility of drug addiction, if it has not been indicated so far. The investigation into the contribution of alpha-1 -antitripsin deficit should be continued.