Interstitial lung damage due to cocaine abuse: pathogenesis, pharmacogenomics and therapy.

Medicinal agents, beside occupational and environmental agents, remain one of the most common causes for interstitial lung diseases (ILD). A major problem with ILD is the recognition of the causative agent. In some cases more or less characteristic features of presentation are described. Often, the connection between drug-use and the development of related inflammatory damage or idiosyncratic toxicities is hard to recognize and objectify. Cocaine, a xenobiotic and the most commonly used illicit drug, causes serious medical and social problems. An increasing incidence of lung toxicity related to cocaine or crack-use is being reported worldwide. However, the mechanism of the resulting lung injury is not fully understood. This review summarizes possible molecular mechanisms explaining intra-individual variability in cocaine response and lung toxicity. The importance of including pharmacogenomics in the work-up of patients with suspected drug-induced lung toxicity is highlighted.