"Bong lung" in cystic fibrosis: a case report

Abstract

Introduction: Marijuana or "bong" lung has been recently described. Subjects typically develop large peripheral paraseptal lung bullae and are predisposed to spontaneous pneumothoraces. The underlying mechanism for bullae formation is uncertain, but probably relates to direct lung toxicity and repeated barotrauma as the smoker performs frequent valsalva manoeuvres in an attempt to derive a greater drug effect.

Case presentation: We describe a case of probable "bong lung" occurring in a 23-year-old Caucasian man with cystic fibrosis who had a history of recurrent pneumothoraces and unusual findings on sputum cytology.

Conclusion: Our case highlights the importance of questioning young adult cystic fibrosis patients about illicit drug use and the utility of sputum cytology and computed tomography scanning when patients present with pneumothoraces and deteriorations in clinical status.

Figure 1

High resolution CT scan of the patient's lungs demonstrating apical bullae. Note the prominent bronchial arteries (arrow).

Figure 2

Sputum cytology using Giemsa stain (x100 magnification and oil immersion lens). Note the brown oily material (arrows) and surrounding PMNs.