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Eosinophilic "empyema" associated with crack cocaine use

¹ Division of Pulmonary and Critical Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
² Cardiovascular Research Center, Medical College of Wisconsin
³ Division of Pulmonary and Critical Care Medicine, University of Colorado and National Jewish Hospital, Denver, Colorado, USA

Correspondence to:
Correspondence to:
Dr J P Maloney, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA;
jmaloney{at}mcw.edu

ABSTRACT
Smoking of crystalline cocaine, known as "crack" cocaine, has been associated with eosinophilic pneumonitis, but not with pleural effusions. We describe a patient with eosinophilic pneumonitis with an eosinophilic "empyema" after using "crack" cocaine. The illness resolved with corticosteroids. We hypothesised that his effusion would have increased levels of eosinophil cytokines that promote oedema, and found a marked increase in pleural vascular endothelial growth factor (VEGF) and smaller increases in interleukins IL-5, IL-6, and IL-8. In the setting of "crack" use, we suggest that a pleural effusion that appears grossly to be pus should be evaluated for eosinophilic inflammation. Such eosinophilic effusions may respond to corticosteroids alone, consistent with a non-infectious process driven by proinflammatory cytokines.

Keywords: pleural disease; "crack" cocaine; interleukins; vascular endothelial growth factor

This article has been cited by other articles:

				C. S. Restrepo, J. A. Carrillo, S. Martinez, P. Ojeda, A. L. Rivera, and A. Hatta Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations RadioGraphics, July 1, 2007; 27(4): 941 - 956. [Abstract] [Full Text] [PDF]