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Carta al Director
Neumotórax espontáneo y consumo de cocaína
Spontaneous pneumothorax and cocaine use
Alfonso Fiorellia, Marina Accardob, Mario Santinia,
Corresponding author
mario.santini@unina2.it

Autor para correspondencia.
a Unidad de Cirugía Torácica, Seconda Università degli Studi di Napoli, Nápoles, Italia
b Departamento de Morfopatología, Seconda Università degli Studi di Napoli, Nápoles, Italia
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El neumot&#243;rax espont&#225;neo &#40;NE&#41; asociado al consumo de marihuana o de coca&#237;na es una enfermedad infrecuente pero conocida&#46; Aunque demostrar efecto directo es un reto&#44; la lesi&#243;n pulmonar causada por el consumo de drogas puede predisponer a un neumot&#243;rax<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; El caso que se presenta es el de un var&#243;n de 39 a&#241;os&#44; que fue remitido a nuestra unidad para recibir tratamiento por NE derecho&#46; Hab&#237;a presentado ya un NE en el mismo lado 7 meses antes y hab&#237;a admitido consumo ocasional de coca&#237;na&#46; Se realiz&#243; pleurodesis mec&#225;nica mediante toracoscopia y resecci&#243;n del &#225;pex del pulm&#243;n derecho&#46; El an&#225;lisis anatomopatol&#243;gico mostr&#243; la inesperada presencia de granulomas no necrosantes incluidos en las paredes bronquiales&#44; asociados a peque&#241;as ves&#237;culas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Su historia cl&#237;nica no ten&#237;a datos de inter&#233;s y todas las pruebas est&#225;ndar de laboratorio&#44; as&#237; como las adicionales para micobacterias&#44; infecciones por hongos y virus de la inmunodeficiencia humana ofrecieron resultados negativos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dado que la coca&#237;na contiene part&#237;culas de talco&#44; supusimos que el dep&#243;sito en las v&#237;as respiratorias habr&#237;a podido causar la formaci&#243;n de granulomas por reacci&#243;n de cuerpo extra&#241;o&#46; El crecimiento de los granulomas afectaba a las peque&#241;as v&#237;as a&#233;reas&#44; provocando retenci&#243;n de aire y enfermedad bullosa&#46; La intensa tos y el broncoespasmo provocado por la inhalaci&#243;n de coca&#237;na provoc&#243; aumento de la presi&#243;n intraalveolar seguido de la rotura de las ves&#237;culas y del neumot&#243;rax&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ward et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> y Pare et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> describieron cambios radiol&#243;gicos significativos tras el consumo de coca&#237;na que inclu&#237;an bullas enfisematosas y fibrosis pulmonar&#46; Recientemente&#44; nuestro grupo mostr&#243; la presencia de ves&#237;culas similares a las que habitualmente se observan en los pacientes ancianos con enfisema en una serie de casos de 13 j&#243;venes que eran fumadores habituales de marihuana<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La presencia de granulomas como &#250;nica expresi&#243;n de da&#241;o pulmonar podr&#237;a explicarse porque nuestro paciente admiti&#243; consumo intermitente de coca&#237;na y no continuo&#46; Sin embargo&#44; la exposici&#243;n continuada a coca&#237;na favoreci&#243; un mayor dep&#243;sito de part&#237;culas de talco&#44; provocando una importante lesi&#243;n pulmonar y los cambios radiol&#243;gicos anteriormente descritos&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; los granulomas debidos al uso espor&#225;dico de coca&#237;na podr&#237;an predisponer al NE incluso en ausencia de cambios radiol&#243;gicos significativos&#46; En todo caso&#44; la mejor manera de prevenir las lesiones graves del par&#233;nquima es evitar en primer lugar el consumo de la droga&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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