Cocaine-Induced Lung Damage and Uncommon Involvement of the Basal Ganglia

Abstract

Cocaine use is responsible for multiorgan damage, including the brain and lungs. Bilateral and symmetrical involvement of the basal ganglia may be due to toxic, metabolic, vascular, inflammatory, infectious, or tumoral causes. Cocaine-related encephalopathy mainly affects the white matter, while basal ganglia involvement is an uncommon finding. Cocaine-induced lung damage varies clinically and even radiologically, with signs that lack specificity. The diagnosis of cocaine-induced lung or brain injury is based on suggestive radiological signs in the context of cocaine consumption and after the elimination of other etiologies likely to present the same patterns. The context of cocaine use is often not spontaneously declared, making diagnosis more complicated. We report the case of a 28-year-old male patient, with a history of freebase cocaine use, admitted to the emergency room in severe coma with respiratory distress. Brain MRI showed bilateral and symmetrical abnormalities of the basal ganglia. A chest CT scan revealed interstitial lung damage dominated by the ground-glass pattern. The urine toxicology test was positive for cocaine. Cocaine-related lesions can be reversible, and therapeutic management is essentially based on supportive care.

Keywords: basal ganglia; cocaine-induced intoxication; ct; lung; mri.

Figure 1. Brain MRI showing bilateral and symmetrical T2 and FLAIR (A) hyperintensity of the basal ganglia with diffusion restriction (B and C).

Blue arrow: T2 FLAIR hyperintensity of the basal ganglia. Yellow arrows: DWI hyperintensity of the basal ganglia. DWI: diffusion-weighted imaging; FLAIR: fluid-attenuated inversion recovery

Figure 2. Chest CT scan showing bilateral ground-glass opacities (A), consolidations (B), emphysematous bullae (C), and pleural effusion (D).

Red arrow: ground-glass pattern. Blue arrow: pulmonary consolidation. Orange arrow: emphysematous bullae. White arrow: left pleural effusion.