title: Eosinophilic "empyema" associated with crack cocaine use.
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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Strong
authors.forename: J Y
authors.initials: JY
authors.lastname: Westcott
authors.forename: J A
authors.initials: JA
authors.lastname: Biller
authors.forename: J L
authors.initials: JL
authors.lastname: Morrison
authors.forename: R M
authors.initials: RM
authors.lastname: Effros
authors.forename: J P
authors.initials: JP
authors.lastname: Maloney
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D019970:Cocaine-Related Disorders / Q000150:complications*; D016578:Crack Cocaine / Q000009:adverse effects*; D016724:Empyema, Pleural / Q000139:chemically induced* / Q000188:drug therapy; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D016578:Crack Cocaine; D005938:Glucocorticoids; D011241:Prednisone