Severe multisystem dysfunction in a case of high level exposure to smoked cannabis

Cannabis use is common, controversial and its clinical toxicology is likely under-recognised. A 56-year-old man presented with disabling shortness of breath. He smoked up to 7 g cannabis daily for 25 years (maximum 63 875 g) plus large amounts of hashish oil. Chest x ray suggested giant bullae. CT of the chest revealed over 40 bullae, the largest being 11 cm in diameter. Osteoporosis with multiple vertebral crush fractures was noted on plain films and bone densitometry (t=-3.19). His dental health was poor. Hypertension, complicated by a large occipital stroke was shown by CT of the brain, and increased vascular age (69.8 years) found by pulse wave analysis. The case is significant as it indicates the potential severity of cannabis lung damage and suggests that significant cannabis exposure may cause osteoporosis and accelerated vascular ageing. The association of alveolar destruction, bone lysis and destruction of arterial elastic laminae suggest possible underlying mechanisms such as tissue proteinase activation, immunomodulation or stem cell impairment.