An unusual presentation of pulmonary complication of crack abuse

Crack inhalation causes a wide spectrum of pulmonary complications and the diagnosis is often delayed or mistaken. We present the case of a 19-year-old woman, mild cigarette-smoker, who referred for asthma not responsive to therapy. A severe obstructive pattern with severe hyperinflation and decreased carbon dioxide diffusing capacity were documented. At HRCT there was evidence of bilateral mild ground glass opacities, diffuse bronchial wall thickening and mosaic perfusion with air trapping in the expiratory phase. Broncho-alveolar lavage showed an increased total cellularity (lymphocytic cells 25%; eosinophilic cells 11%; CD4/CD8