(1169) Diffuse Alveolar Hemorrhage Secondary to Fentanyl Inhalation and Overdose

Introduction: Diffuse Alveolar Hemorrhage (DAH) can be life-threatening and the predominant drug-induced reported cause is cocaine abuse. Fentanyl inhalation or insufflation is not reported as a common cause of DAH. We present a novel case of diffuse alveolar hemorrhage secondary to fentanyl inhalation.

Methods: An HCA database search was conducted with the permission of the HCA Healthcare registry to obtain and collect subset data that lists the incidence of DAH secondary to Fentanyl inhalation comparing and contrasting their clinical course and outcome. Sociodemographic information were all drawn from the literature review and compared to the existing registry.

Results: Eight cases of DAH secondary to fentanyl overdose were reported in the literature: listing demographic information (age and gender), clinical features, Urine Drug Screen, Bronchoalveolar lavage (BAL), serology, and outcome were reported. The ages of the reported cases of DAH secondary to fentanyl overdose were ranging from 18 to 45 years of age. 8 out of the 8 (100%) cases presented with acute hypoxic respiratory failure and hemoptysis. 4 out of the 8 cases (50%) received Narcan. 5 out of the 8 cases (62.5%) were intubated and mechanically ventilated. The UDS in 4 out of the 8 cases (50%) were positive for cannabinoids (i.e. possible laced marijuana) and 8 out of the 8 cases were negative for cocaine (100%). The autoimmune workup was negative in 8 out of 8 cases (100%). BAL was consistent with DAH in 5 out of 8 cases (62.5%), the remaining 3 out of 8 cases (37.5%) were either unspecified or did not undergo BAL. All patients received systemic steroids therapy. Recovery was evident in 5 out of 8 cases (62.5%), the remaining outcome in 3 out of 8 cases (37.5%) was unspecified. DAH secondary to fentanyl overdose was more prevalent in men; in 8 out of the 8 cases (100%). The average age was 30 +/- 8.55. Our case describes a patient with hypoxic respiratory failure secondary to DAH in the context of fentanyl inhalation.

Conclusions: Increasing rates of drug abuse, particularly fentanyl, may lead to more presentations of unusual effects of opioid toxicity like DAH. Physician early recognition of this complication and crisis is imperative for proper management of such patients, in light of the ongoing fentanyl epidemic.